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  • This is a presentation about the use of respirators in

  • healthcare settings.

  • In certain situations, healthcare workers may need to

  • be protected from airborne hazards, such as infectious

  • agents or hazardous chemicals in their workplace.

  • Respirators are a type of personal protective equipment,

  • or PPE, that can protect you from breathing in such hazards.

  • After viewing this video, you should

  • have a basic understanding of why respirators are used

  • in the healthcare industry, and how to properly use them.

  • You should also understand that a standard

  • issued by OSHA - the Occupational Safety and Health

  • Administration - or by an OSHA-approved State plan,

  • requires your employer to have a comprehensive

  • respiratory protection program whenever respirators

  • must be used.

  • In addition, this video will discuss some

  • common myths about respirators that you may hear in

  • your workplace.

  • It is required that you understand how to use a

  • respirator, and understand the major components of a

  • respiratory protection program.

  • This video may be a part of your respiratory protection training,

  • but it’s not a substitute for the more in-depth, worksite-specific

  • training that your employer is required to provide.

  • While this video discusses your employer’s

  • responsibilities under OSHA’s respiratory protection

  • standard, remember that the purpose of a respirator is

  • to protect your health and safety.

  • So let’s begin:

  • Airborne hazards may be solid particles - like dusts -

  • droplets - like mists -

  • or gases.

  • When such hazards are present in your workplace, your

  • employer must control them in several ways, including

  • engineering controls, work practice controls, and

  • administrative controls.

  • When workers cannot be adequately protected from

  • respiratory hazards through engineering, work practice,

  • and administrative controls, employers must provide,

  • and workers must use, personal protective equipment,

  • also known as PPE.

  • Respirators are a type of PPE used to protect workers

  • against breathing airborne hazards and they are often

  • used with other types of PPE such as gloves, goggles,

  • and procedure gowns.

  • In this presentation, one of our goals is to set the record

  • straight about the proper use of respirators in

  • healthcare settings.

  • So during this video we will take a look at some of the

  • misconceptions, or myths that you may encounter in

  • your workplace.

  • Myth: Respirators are only necessary for tuberculosis

  • or TB - exposures.

  • Actually there are a number of situations in healthcare

  • settings where workers may need to wear a respirator

  • to protect against airborne hazardsTB is only one of them.

  • There are two primary types of respiratory hazards in

  • healthcare settingsairborne infectious agents and

  • gaseous chemical exposures.

  • Let’s take a look at these two types of hazards, the ways

  • workers might be exposed to them and how they can be

  • protected from them.

  • First let’s look at airborne infectious agents.

  • Probably the most common use of respirators in

  • healthcare settings is to protect workers against

  • airborne infectious agents that cause diseases such as

  • tuberculosis, SARS, pandemic influenza, chicken pox, and measles.

  • Healthcare workers are exposed to these

  • hazards during the care of patients suspected or

  • confirmed to have airborne transmissible diseases.

  • Workers might also be exposed when they enter a

  • negative pressure airborne infection isolation roomor AIIR;

  • when they are present during aerosol-generating medical

  • or laboratory procedures or during

  • autopsies on suspected or confirmed infectious individuals;

  • when they transport infectious patients in an enclosed vehicle;

  • and when they function as first receivers of

  • victims from a biological agent attack.

  • Patient care isn’t the only situation where respiratory

  • protection may be needed to protect workers against

  • airborne transmission.

  • For example, laboratory personnel working with

  • highly infectious agents may need respiratory protection.

  • Also, engineering and maintenance staff may be

  • exposed during tasks such as replacing filters in an

  • isolation room or a laboratory hood ventilation system.

  • Now let’s talk about gaseous chemical exposures.

  • Workers in healthcare settings may also need to use

  • respirators to protect against airborne chemical

  • exposures from substances such as pharmaceuticals

  • during dose preparation, sterilants, like glutaraldehyde,

  • and fixatives like formaldehyde.

  • It’s very important to understand that the respirators

  • used to protect against infectious agents may be

  • inappropriate to protect against chemical hazards.

  • We will discuss respirator selection in more detail later

  • in the program.

  • When a respirator is required by your employer, your

  • employer must develop and implement a

  • comprehensive respiratory protection program.

  • This program must meet the requirements of either Federal

  • or State OSHA’s Respiratory Protection Standard.

  • Employers must comply with the standard, and you

  • need to have a basic understanding of their responsibilities.

  • Your employer must:

  • identify and evaluate hazards;

  • develop a written program;

  • properly select respirators;

  • evaluate respirator use;

  • correct any problems with respirator use;

  • conduct medical evaluations and fit testing;

  • provide for the maintenance, storage and cleaning of respirators;

  • provide training;

  • and provide you with access to specific

  • records and documents, such as a written copy of your

  • employer’s respiratory protection program.

  • Because each workplace is different, your employer’s

  • respiratory protection program must be tailored to your

  • specific workplace.

  • For example, workplaces will differ

  • in types of respiratory hazards, designated personnel,

  • policies, procedures, and methods of compliance.

  • These differences must be reflected in the employer’s program.

  • Your employer’s respiratory protection program must

  • be managed by a properly trained program administrator.

  • Their job is to monitor the implementation of the

  • program and to make sure that workers are properly protected.

  • Myth: Surgical masks provide the same protection as respirators.

  • Respirators and surgical masks are two types of

  • personal protective equipment - or PPE - that are

  • used to protect workers in healthcare settings.

  • A surgical mask is not a respirator, and that’s an

  • important distinction for you and your employer to

  • understand, so let’s review the significant differences

  • between a respirator and a surgical mask.

  • What is a respirator? A respirator is a type of personal

  • protective equipment designed to reduce your

  • exposure to airborne contaminants.

  • Respirators are available in different types and sizes,

  • and the respirator you use must be individually selected

  • to fit your face and to provide a tight seal.

  • A proper seal between your face and the respirator

  • forces inhaled air to be pulled

  • through the respirator’s filter material, and not through

  • gaps between your face and the respirator.

  • If your supervisor requires you to use a respirator, it

  • must be NIOSH-certified and must be used in the

  • context of a comprehensive respiratory protection

  • program, according to OSHA’s Respiratory Protection

  • standard, twenty nine CFR nineteen ten point one thirty

  • four, which includes but is not limited to medical

  • evaluation, fit testing, and training elements.

  • Respirators are used routinely to protect healthcare

  • workers against airborne infectious diseases, such as

  • tuberculosis, anthrax, SARs, and Hantavirus because

  • they protect against both large and small particles.

  • What is a Facemask? A facemask is a loose-fitting,

  • disposable mask that covers your nose and mouth.

  • Surgical masks, dental masks, medical procedure masks,

  • isolation masks and laser masks are all types of facemasks.

  • Facemasks help stop large droplets from being spread

  • by the person wearing them, whether that person is a

  • patient or a healthcare worker.

  • Facemasks also keep splashes or sprays from reaching the

  • mouth and nose of the person wearing them.

  • However, facemasks are not designed or certified

  • to seal tightly against your face or

  • to prevent the inhalation of small airborne contaminants.

  • During inhalation, small airborne contaminants pass

  • through gaps between the face and the facemask and

  • the material of the mask.

  • Remember, facemasks are not considered respirators

  • and they do not provide respiratory protection.

  • Only facemasks that are cleared by the U.S.

  • Food and Drug Administration, the FDA for short, may be legally

  • marketed in the United States.

  • The FDA approval signifies that they have been tested for their ability to

  • resist splashes of blood and other body fluids.

  • To offer protection, both facemasks and respirators

  • need to be worn correctly and consistently throughout

  • the time that they are being used.

  • When used properly, facemasks and respirators both play

  • an important role in preventing exposures to different types of hazards.

  • If you need the protection of both a facemask and a

  • respirator, you can use a surgical N95 respirator.

  • Surgical N95 respirators offer protection from both

  • airborne and body fluid contaminants and are approved

  • by both NIOSH and the FDA.

  • Your employer is responsible for selecting appropriate

  • respirators when they are needed to protect you from

  • airborne hazards.

  • That selection is based in part on the

  • level of protection a given type of respirator can provide.

  • And this brings us to another myth:

  • All respirators offer the same level of protection.

  • The truth is that different types of respirators protect

  • against different hazards and offer different levels of protection.

  • So when your employer selects respirators

  • they must first identify the hazard and then consider

  • these two factors: the respirator’s level of protection

  • and the expected workplace exposure level.

  • Your employer must also consider whether the hazard

  • has any additional characteristics that may affect the

  • type of respirator selected.

  • For example, does the hazard irritate the eyes?

  • Do you need splash and spray protection, as well as eye protection?

  • If so, a full facepiece respirator or some type of

  • eye protection will be needed.

  • There are advantages and disadvantages to each type of

  • respirator, so it’s important that your employer select the type

  • that’s best suited for your work setting and the hazards you face.

  • These are filtering facepiece respirators, sometimes

  • referred to as N95s or TB respirators.

  • They come in a variety of configurations, such as cup shaped,

  • flat fold, and duckbill.

  • Because this is a tight-fitting respirator, it needs to be fit

  • tested to assure a good face seal.

  • This type is commonly used by healthcare providers

  • during patient care.

  • Filtering facepiece respirators do not protect

  • against gaseous chemical hazards, such as

  • formaldehyde and glutaraldehyde, and must not be

  • used for such purposes.

  • Filtering facepiece respirators are available with or

  • without exhalation valves.

  • Respirators with exhalation valves should not be

  • used where a sterile field must be maintained,

  • such as in an operating room.

  • The Surgical N95 respirator, shown here, is used in

  • situations that require the protection of both a surgical

  • mask and a respirator.

  • This is an elastomeric half-facepiece respirator.

  • This type needs to be fit tested and can be used instead of a

  • filtering facepiece respirator.

  • Some healthcare providers are beginning to use this

  • type of respirator for protection against infectious agents.

  • An elastomeric half-facepiece respirator can be cleaned,

  • decontaminated, and reused.

  • Remember, this is not the case for a filtering facepiece

  • respirator, which is normally discarded after use.

  • This is an elastomeric full-facepiece respirator.

  • This type of respirator provides a higher level of protection

  • than filtering facepiece and elastomeric half-facepiece respirators.

  • Why? Because it provides a better seal to the wearer’s face.

  • Another advantage of this respirator is that it covers the

  • wearer’s eyes, protecting them from liquid splashes and chemical vapors.

  • It might be used by workers exposed to formaldehyde

  • or by laboratory, pharmacy, or maintenance personnel.

  • In addition, it could be used by healthcare workers who

  • are first receivers of victims of hazardous substance

  • releases, or by a healthcare facility’s internal hazmat team.

  • This is a loose-fitting facepiece hooded powered air-

  • purifying respirator, also known as a PAPR.

  • A PAPR has a blower that pulls air through attached filters.

  • The blower then pushes the filtered air into the facepiece,

  • which covers all of the wearer's face.

  • Since it is loose-fitting, it does not need to be fit tested and can be used

  • by workers with facial hair.

  • A PAPR might be used by healthcare providers during

  • direct patient care, and for high exposure risk, aerosol-

  • generating medical and laboratory procedures.

  • These would include bronchoscopy and sputum induction, and

  • during autopsies.

  • In addition, a PAPR might be used by laboratory,

  • pharmacy, or maintenance personnel.

  • There are also full-facepiece PAPRs, as well as PAPRs

  • that have a helmet.

  • When respiratory protection is needed, OSHA requires

  • employers to provide NIOSH-certified respirators to their workers.

  • To see if your respirator is NIOSH-certified, look for the NIOSH logo,

  • as well as the test and certification approval number, or TC number.

  • These can be found on the respirator’s package or user

  • instruction insert, and sometimes they appear directly

  • on respirator components, such as the respirator filter or cartridge.

  • If your respirator is not NIOSH-certified,

  • do not use it in a hazardous area.

  • Myth: It is ok to decorate, write on, or otherwise alter

  • your respirator to make it look more appealing.

  • You must never alter your respirator.

  • Doing so can reduce its protective quality and expose you to the

  • airborne hazard.

  • Never glue or staple things to your respirator;

  • don’t write on your respirator’s filter material; and you must

  • never puncture holes in your respirator.

  • In fact, OSHA requires that respirators be used only in

  • ways that comply with the conditions of their NIOSH certification.

  • Only practices that do not affect the respirator’s ability

  • to protect you are allowed, such as writing your name

  • on your respirator’s straps.

  • Here’s another myth: Anyone can wear a respirator.

  • Not everyone is able to wear a respirator.

  • Before you use a respirator, your employer must evaluate whether

  • you are medically able to wear it.

  • Some conditions that could prevent you from using a

  • respirator include heart conditions, lung disease, and

  • psychological conditions like claustrophobia.

  • A physician or other licensed healthcare professional,

  • such as a registered nurse or physician’s assistant, must

  • perform a medical evaluation that considers your health

  • and your specific job description.

  • The evaluation can be

  • as simple as using the medical questionnaire contained

  • in Appendix C of OSHA’s Respiratory Protection Standard.

  • This questionnaire is designed to identify general

  • medical conditions that could place a worker at risk of

  • serious medical consequences, if a respirator is used.

  • It’s important to answer the questions truthfully.

  • Based on your answers to the questionnaire, the doctor

  • or licensed healthcare professional may decide that a

  • medical examination or tests are necessary to

  • determine if you can safely wear a respirator.

  • If you need these additional tests, your employer is

  • responsible for paying for them, and for ensuring that

  • they are provided during your normal working hours, or

  • at a time and place that’s convenient for you.

  • Your responses to the medical questionnaire are

  • confidential and should not be shared with your employer.

  • After the medical evaluation, the physician or licensed

  • healthcare professional will provide you and your

  • employer with a written recommendation.

  • This recommendation must not include

  • confidential medical information.

  • It must state three things: First, your ability to wear a

  • respirator and any functional limitations on your use of

  • certain types of respirators.

  • Second, the need, if any, for follow-up medical evaluations.

  • And, third, a statement that the doctor or licensed health care

  • professional has provided you with

  • a copy of their written recommendation.

  • Your completed questionnaire is typically maintained by

  • the physician or licensed healthcare professional, along

  • with the rest of your medical records.

  • If your employer maintains these records,

  • then your employer must keep

  • this information confidential and filed separately from

  • your Human Resources - or HR - files.

  • And now, it’s time for another myth: There is no benefit

  • to fit-testing and the only reason to do it is to comply

  • with OSHA standards.

  • If your respirator doesn’t fit properly, contaminated air

  • can leak into the facepiece, and you will not be protected.

  • It’s that simple.

  • Remember, a tight fitting respirator must form and

  • maintain a tight seal with the face or neck in order to

  • protect the wearer from airborne hazards.

  • So before you wear a tight-fitting respirator in the workplace, you

  • must be fit tested with the specific make, model, style,

  • and size of that respirator.

  • The purpose of fit testing is to be sure that the

  • facepiece of the selected respirator fits adequately to

  • your unique facial characteristics.

  • Some people cannot be fitted with a particular respirator.

  • They may require a different make, model, or size of respirator.

  • Or they may require another type or class of respirator.

  • So what is a fit test? A fit test is designed to test the

  • facepiece-to-face seal of the respirator.

  • It can be either qualitative or quantitative, and uses a

  • test agent or instrument to verify the respirator’s fit.

  • This process typically requires fifteen to twenty minutes to complete.

  • Your respirator must be fit tested before you use it in

  • the workplace, and must be retested at least annually

  • to ensure a continued good fit.

  • The fit of your respirator must also be retested

  • whenever you have a significant change in weight,

  • significant dental work - such as new dentures

  • significant facial surgery, or significant scarring of the

  • face in the area of the seal.

  • When youve completed the fit testing process, it’s very

  • important that you know which make, model, and size

  • respirator fits your face properly, and when and where

  • youll need to wear it for protection.

  • Since no single respirator can be expected to fit all the

  • many types of faces found in the workplace, your

  • employer needs to provide you with a reasonable

  • selection of sizes and models to choose from.

  • If you find that your respirator becomes uncomfortable

  • or significantly limits your vision or ability to

  • communicate, or is otherwise unacceptable, you must

  • be given an opportunity to select a different type of

  • respirator and be retested.

  • The selection may include a

  • new make, model, or size of respirator.

  • Many workers need to wear prescription glasses or

  • personal protective equipment such as safety glasses or

  • goggles, or earmuffs while performing a job.

  • If you wear prescription glasses, or your job requires

  • you to wear PPE like safety glasses, goggles, or hearing

  • protection, you must wear these items during the fit

  • test to be sure they don’t interfere with the respirator’s fit.

  • If you wear a tight-fitting respirator, remember: facial

  • hair can not come between the sealing surface of the

  • respirator and your face, or interfere with your

  • respirator’s valve function.

  • Also, people with long hair must make sure it doesn’t

  • interfere with the respirator’s ability to seal tightly to the face.

  • Myth: Putting on and taking off a respirator does not

  • require special procedures.

  • The truth is that putting on and taking off your

  • respirator requires step-by-step procedures.

  • Consequently, the training provided to you by your

  • employer must include how to properly put on and take

  • off your respirator, and how to conduct a user seal

  • check when you put it on.

  • A user seal check is a way to

  • verify that the respirator has been properly positioned

  • on your face to assure a proper seal.

  • It must be performed each time you put on a respirator to check

  • that it has been donned correctly.

  • A user seal check is not the same as a fit test, and is not

  • a substitute for a fit test.

  • To see a short video containing general instructions on

  • how to properly put on and take off a respirator, and

  • how to conduct a user seal check, refer to this OSHA website.

  • Myth: Respirators are maintenance-free.

  • Your employer’s respiratory protection program must

  • provide for the cleaning, disinfecting, storage,

  • inspection, and repair of each type of respirator used in

  • your workplace.

  • Remember, all respirators must be inspected for basic

  • function prior to each use.

  • Reusable respirators must be cleaned as often as necessary

  • to prevent them from becoming unsanitary, while filtering facepiece

  • respirators must be disposed of when they become

  • soiled or no longer provide protection.

  • A respirator inspection must include a check of the

  • respirator function, tightness of any connections, and

  • the condition of the various parts, such as the

  • facepiece, head straps, valves, tubes, hoses, and any

  • cartridges, canisters, or filters.

  • In addition, elastomeric parts must be checked for pliability

  • or signs of deterioration.

  • Regular care and maintenance of the

  • respirator is important to ensure that it functions as designed.

  • It is also important for respirators to be stored properly,

  • to protect them from damage, contamination, dust,

  • sunlight, extreme temperatures, excessive moisture,

  • and damaging chemicals.

  • In addition, they must be stored to prevent the

  • facepiece and exhalation valve from being damaged.

  • Avoid carrying a cup-shaped filtering facepiece

  • respirator in your pocket or in a bag.

  • This could crush or distort its shape and prevent the respirator from sealing

  • tightly to your face, thus compromising your protection.

  • Myth: A respirator is only effective for a short period of

  • time and cannot be reused.

  • A properly functioning respirator can provide effective

  • protection for as long as the filters or cartridges work correctly.

  • All filters must be replaced whenever they

  • are damaged, soiled, or cause noticeably increased breathing resistance.

  • Before you use your respirator, you must inspect the

  • outside of the filter material.

  • If your respirator has replaceable filters and those filters

  • appear to be damaged or soiled, they must be changed.

  • If your respirator is a filtering facepiece and the filter

  • material appears to be damaged or soiled, the

  • respirator must be discarded.

  • Remember your employer must develop standard

  • operating procedures for storing, reusing, and disposing

  • of respirators that have been designated as disposable.

  • The same is true for respirators with replaceable filter elements.

  • Of course, there may be other reasons for disposing of a

  • filtering facepiece respirator that still appears to be functional.

  • For example, sometimes infection control

  • procedures may require that a respirator be used only once.

  • Your employer must identify the circumstances in

  • which a filtering facepiece respirator will be considered

  • to be contaminated and not available for reuse.

  • Some gas and vapor hazards require the use of

  • respirator cartridges or canisters that contain materials

  • to absorb or remove the hazards from the air.

  • These cartridges or canisters have a limited service life

  • because they can absorb only a limited amount of

  • hazardous gas or vapor.

  • To assure your protection they must be replaced before

  • they reach this limit.

  • This schedule for replacing worn out cartridges or

  • canisters is known as a change out schedule.

  • Your employer is responsible for providing this information to you.

  • Remember, you must never rely on your ability

  • to smell a contaminant to warn you of cartridge or

  • canister failure.

  • A respirator can’t protect you if you don’t know how to

  • use it properly.

  • So before you use a respirator, your employer must train

  • you about its use.

  • This training must be provided in a way that you can

  • understand and must include at least the following information:

  • Why the respirator is necessary;

  • what the limitations and capabilities of the respirator are;

  • how to inspect, put on and take off, use, and conduct a

  • user seal check of the respirator;

  • how to use the respirator effectively in emergency situations,

  • including situations in which the respirator malfunctions;

  • how to recognize medical signs and

  • symptoms that may limit or prevent you from using a respirator;

  • how improper fit, usage, or maintenance can reduce a respirator’s protection;

  • what the procedures are for maintenance and

  • storage of the respirator; and

  • the requirements of OSHA’s Respiratory Protection Standard.

  • You must be trained before you use a respirator, but

  • this is not the only time that your employer must provide training.

  • If you use a respirator at work, your employer must

  • provide respirator training to you at least every year.

  • This annual retraining will refresh your memory on the

  • information and skills you need to properly use your

  • respirator, and will help ensure your protection.

  • It also gives you the opportunity to ask questions and discuss

  • worksite-specific respirator use with your instructor.

  • In addition, you must be retrained when:

  • Changes in your workplace or the type of respirator you

  • use make your previous training out-of-date.

  • For example, a process change results in you being exposed

  • to a new hazardous substance in your workplace.

  • You can’t remember the information and skills you need

  • to properly use your respirator.

  • This could occur when your supervisor sees that youre not using your

  • respirator properly or when it’s apparent that you don’t

  • fully understand, or have forgotten, important information.

  • Or when a situation comes up in which re-training is

  • necessary to ensure safe respirator use.

  • Most workers who wear respirators use them because

  • they are required to do so by their employer in order to

  • protect them from airborne hazards.

  • There are some situations where workers may request to wear a

  • respirator even though respirator use is not required

  • under an OSHA standard or by your employer.

  • If your employer permits this, it is considered voluntary

  • respirator use.

  • If you are voluntarily using only filtering facepiece

  • respirators, your employer is required to provide you

  • with a copy of Appendix D of OSHA’s Respiratory

  • Protection Standard, or the equivalent State plan

  • document, which contains certain precautions to be taken.

  • Your employer is also required to ensure that

  • the use of the respirator itself is not creating a health

  • hazard to you, such as dermatitis.

  • If other types of respirators are used voluntarily, your

  • employer must establish and implement those elements

  • of a written program necessary to ensure that you are

  • medically able to use the respirator, and that the

  • respirator is cleaned, stored and maintained so that its

  • use does not present a health hazard to you.

  • Remember, voluntary use is only permitted when your

  • employer has determined that there is no airborne

  • hazard that would require the use of a respirator.

  • If you have additional questions about either the

  • airborne hazards found in your workplace or respirator

  • use in your workplace, ask your supervisor or

  • respiratory protection program administrator.

  • For additional information on respiratory protection in the

  • workplace, consult these OSHA and NIOSH websites.

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