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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 hazards – TB is only one of them.
There are two primary types of respiratory hazards in
healthcare settings – airborne 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 room – or 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 you’ve 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
you’ll 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 you’re 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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Respiratory Protection for Healthcare Workers Training Video

3290 Folder Collection
kuoyumei published on May 1, 2015
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