Complying with OSHA’s Respiratory Protection Standard

As reported in previous AHCA memos, the Occupational Safety and Health Administration (OSHA) issued a final rule that extends the general industry respiratory standard to health care facilities. The rule is scheduled for implementation on July 1, 2004. It is possible that OSHA may delay implementation beyond July, but notification of such a delay is not likely to occur before mid-June. In the event that OSHA does not delay implementation, we want you to be aware of the many new requirements under the Respiratory Protection Standard 1910.134. Affected employers will need to revise their respiratory protection program, conduct annual respiratory fit testing, provide a medical evaluation and conduct annual training for employees using respirators.

This rule does not apply to all long term care facilities. Under “Affected Establishments” the rule (found at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=18051) states, “The scope of this action is limited to establishments in the health services industry (SIC 80) that follow the CDC guidelines and provide respiratory protection for employees potentially exposed to tuberculosis. These establishments are primarily hospitals. To the extent that patients with active tuberculosis may be treated in other health service facilities, such as those that may be affiliated with nursing homes, correctional facilities, or substance abuse treatment facilities, these may also be potentially affected by this action.” Accordingly, AHCA believes that the rule applies to long term care facilities that choose to care for TB patients and not to facilities that elect to transfer such patients and have clear transfer policies that result in immediate transfers. Informally, OSHA has confirmed this interpretation, but we are awaiting written confirmation from OSHA that this interpretation is correct.

For those facilities that fall under the Respiratory Protection Standard, the following summarizes requirements under 1910.134. For a full understanding of the requirements, access the Respiratory Protection Standard at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=12716.

Summary of OSHA Standard 1910.134 Respiratory Protection

Section 1910.134 (c) Respiratory protection program. In any workplace where respirators are necessary to protect the health of the employee or whenever respirators are required by the employer, the employer must establish and implement a written respiratory protection program with worksite-specific procedures and must update the program as necessary to reflect those changes in workplace conditions that affect respirator use. The program should include, as applicable:

• Procedures for selecting respirators for use in the workplace;
• Medical evaluations of employees required to use respirators;
• Fit testing procedures for tight-fitting respirators;
• Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations;
• Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators;
• Procedures to ensure adequate air quality, quantity, and flow of breathing air for atmosphere-supplying respirators;
• Training of employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations.
• Training of employees in the proper use of respirators, including putting on and removing them, any limitations on their use ad their maintenance; and
• Procedures for regularly evaluating the effectiveness of the program.

Where respirator use is not required, an employer may provide respirators at the request of employees or permit employees to use their own respirators if the employer determines that such respirators will not in itself create a hazard. If respirators are allowed, employers must provide users with the information in Appendix D to the Standard (found at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9784) and implement those elements of a written respiratory protection program necessary to ensure that any employee using a respirator voluntarily is medically able to use that respirator, and that the respirator is cleaned, stored and maintained so that its use does not present a health hazard to the user. Exception: Employers are not required to include in a written respiratory protection program those employees whose only use of respirators involves the voluntary use of filtering facepieces (dust masks).

Employers must designate a program administrator who is qualified by appropriate training or experience that is commensurate with the complexity of the program to administer or oversee the respiratory protection program and conduct the required evaluations of program effectiveness. Employers must provide respirators, training, and medical evaluations at no cost to employees.

Section 1910.134(d) Selection of respirators. Employers must evaluate respiratory hazard(s) in the workplace, identify relevant workplace and user factors, and base respirator selection on these factors. This paragraph also specifies appropriately protective respirators for use in immediately dangerous to life and health (IDLH) atmospheres, and limits the selection and use of air-purifying respirators. Respirators must be NIOSH-certified.

Section 1910.134(e) Medical evaluation. Employers must provide medical evaluations to determine an employee’s ability to use a respirator before the employee is fit tested or required to use the respirator in the workplace. The medical evaluation may be discontinued when the employee no longer is required to use a respirator. Medical evaluation procedures include identifying a physician or other licensed health care professional (PLHCP) to perform medical evaluations during normal working hours or at a time and place convenient to the employee, ensuring follow-up medical examinations as needed based on results of initial exam, and providing information to the PLHCP, including the type and weight of the respirator and the standard itself. Appendix C of the Standard contains a mandatory medical evaluation questionnaire (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9783). In determining an employee’s ability to use a respirator, an employer must obtain a written recommendation from the PLHCP that provides only information on limitations on respirator use, need, if any, for follow-up medical evaluations and a statement that the employee has received a copy of the recommendations. Additional medical evaluations may be required if, for example, an employee reports medical signs or symptoms that are related to ability to use a respirator or a change occurs in workplace conditions that may result in a substantial increase in the physiological burden placed on an employee.

Section 1910.134(f) Fit testing. Before an employee is required to use any respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used. This paragraph specifies the kinds of fit tests allowed, the procedures for conducting them, and how the results of the fit tests must be used as follows:

• The employer shall ensure that employees using a tight-fitting facepiece respirator pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.
• The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter.
• The employer shall conduct an additional fit test whenever the employee reports, or the employer, PLHCP, supervisor, or program administrator makes visual observations of, changes in the employee's physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.
• If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program administrator, supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall be given a reasonable opportunity to select a different respirator facepiece and to be retested.
• The fit test shall be administered using an OSHA-accepted QLFT or QNFT protocol, which may be found in Appendix A of the Standard (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9780).
• QLFT may only be used to fit test negative pressure air-purifying respirators that must achieve a fit factor of 100 or less.
• If the fit factor, as determined through an OSHA-accepted QNFT protocol, is equal to or greater than 100 for tight-fitting half facepieces, or equal to or greater than 500 for tight-fitting full facepieces, the QNFT has been passed with that respirator.
• Fit testing of tight-fitting atmosphere-supplying respirators and tight-fitting powered air-purifying respirators shall be accomplished by performing quantitative or qualitative fit testing in the negative pressure mode, regardless of the mode of operation (negative or positive pressure) that is used for respiratory protection.

1910.134 (g) Use of respirators. Employers must establish and implement procedures for the proper use of respirators. These requirements include prohibiting conditions that may result in facepiece seal leakage, preventing employees from removing respirators in hazardous environments, taking actions to ensure continued effective respirator operation throughout the work shift, and establishing procedures for the use of respirators in IDLH atmospheres. Appendix B-1 provides user seal check procedures (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9781), but employers also may use procedures recommended by the respirator manufacturer if they are as effective.

1910.134 (h) Cleaning and disinfecting. Employers must provide for the cleaning and disinfecting, storage, inspection, and repair of respirators used by employees. Cleaning and disinfecting intervals are specified based on use, and cleaning and disinfecting procedures are specified in Appendix B- 2 (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9782). Respirators must be stored to protect them from damage, but must be accessible to the work area. Regular inspections are required.

1910.34 (i) Breathing air quality and use. Employers must provide employees using atmosphere-supplying respirators (supplied-air and self-contained breathing apparatus) with breathing gases of high purity as delineated in this paragraph.

1910.34 (j) Identification of filters, cartridges, and canisters. Employers must ensure that all filters, cartridges and canisters are labeled and color coded with the NIOSH approval label and that the label is not removed and remains legible.

1910.34 (k) Training and information. Employers must provide effective training to employees who are required to use respirators. The training must be comprehensive, understandable, and recur annually and more often if necessary. Also, employers must provide basic information on respirators (found in Appendix D of this Standard) to employees who wear respirators when not required to do so. Employers must ensure that each employee can demonstrate knowledge of at least the following:

• Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective effect of the respirator;
• What the limitations and capabilities of the respirator are;
• How to use the respirator effectively in emergency situations, including situations in which the respirator malfunctions;
• How to inspect, put on and remove, use, and check the seals of the respirator;
• What the procedures are for maintenance and storage of the respirator;
• How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators; and
• The general requirements of this section.

Training must be provided prior to respirator use. Training does not have to be repeated if a new employee had training within the last 12 months and can demonstrate knowledge. Retraining must be administered annually and when the following situations occur:

• Changes in the workplace or the type of respirator render previous training obsolete;
• Inadequacies in the employee's knowledge or use of the respirator indicate that the employee has not retained the requisite understanding or skill; or
• Any other situation arises in which retraining appears necessary to ensure safe respirator use.

1910.34(l) Program evaluation. Employers must conduct workplace evaluations to ensure that the written respiratory protection program is being properly implemented, and to consult employees to ensure that they are using the respirators properly and to assess their views on program effectiveness and to identify any problems. Any problems that are identified during this assessment must be corrected. Factors to be assessed include, but are not limited to:

• Respirator fit (including the ability to use the respirator without interfering with effective workplace performance);
• Appropriate respirator selection for the hazards to which the employee is exposed;
• Proper respirator use under workplace conditions the employee encounters; and
• Proper respirator maintenance.

1910.134(m) Recordkeeping. Employers must establish and retain written information regarding medical evaluations, fit testing, and the respirator program. The fit testing record must include name or identification of the employee tested, type and date of test, specific make, model, type and size of respirator tested, and test results. Fit test records are retained until the next fit test is administered.​