Subtitles section Play video Print subtitles 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.