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Healthcare-Associated Infections: Respiratory Protection Programs

The Occupational Safety and Health Administration’s (OSHA) Respiratory Protection Standard (29CFR 1910.134) requires that health care employers establish and maintain a respiratory protection program (RPP) in workplaces where workers may be exposed to respiratory hazards. Per OSHA standards, the use of respirators requires medical evaluation and fit testing.

This webpage includes information, answers to frequently asked questions, and resources on RPPs.

Respirators

If respirators are used, OSHA requires the development, implementation, administration, and periodic re-evaluation of the RPP. Respirators are often used in health care to protect against exposures to airborne transmissible infectious diseases (including those caused by bacteria like tuberculosis (TB) or viruses like SARS-CoV-2), as well as chemicals and certain drugs that may be used in health care settings.

Respirators protect the user in two basic ways, either by filtering contaminated ambient air or by providing a clean source of air. Like other personal protective equipment (PPE), the selection of a respirator type must consider the nature of the exposure and risk involved. For example, N95 particulate respirators might be worn by personnel entering the room of a patient with infectious tuberculosis. However, if a bronchoscopy is performed on the patient, the health care provider might wear a higher level of respiratory protection, such as a powered air-purifying respirator.

These are sometimes referred to as disposable particulate respirators because the entire respirator is discarded when it becomes unsuitable for further use due to considerations of hygiene, excessive resistance, or physical damage.

The most commonly used respirators in health care settings are the N95, N99, or N100 particulate respirators.

The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameter.

These are sometimes referred to as reusable respirators because the facepiece is cleaned and reused while the filter cartridges and canisters are discarded and replaced when they become unsuitable for further use.

These are battery-powered respirators in which a blower moves the air through the filters to the user.

Medical evaluation

An initial medical evaluation must be completed before an employee can wear a respirator and periodically thereafter as determined by a physician or other licensed health professional. In addition, an evaluation must be completed:

  • If an employee reports signs and symptoms related to the ability to wear a respirator.
  • If the RPP administrator requires it.
  • If observations made during fit testing indicate the need for a medical evaluation.
  • If changes in the workplace conditions occur that may result in increased physical burdens to the employee.

Fit testing

All respirators that fit tightly on the face must be fit tested (including N95 filtering face pieces and PAPRs with half or full face pieces).

Fit testing must occur:

  • Before an employee first uses a respirator.
  • At least annually after an employee first uses a respirator.
  • Before a different make or model of respirator is used.
  • When there are changes in an employee’s physical condition that may affect the fit of the respirator (such as significant weight changes or changes in facial features).

TB exposures

Respiratory protection measures that include use of N95 respirators are also necessary for public health and health care personnel with exposure to active TB cases.

In settings where RPPs are required, enough health care personnel should be included to provide adequate care for patients with suspected or confirmed TB disease.

The number of health care personnel included in the RPP will vary depending on:

  • The number of people with suspected or confirmed TB disease examined in a setting.
  • The number of rooms or areas in which patients with suspected or confirmed infectious TB disease were encountered.
  • The number of health care personnel needed to staff these rooms or areas.

See the TB Risk Assessment worksheet (Appendix B) in the Centers for Disease Prevention and Control’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, for more information.

Frequently asked questions

Although no specific requirements are listed in the OSHA Respiratory Protection Standard, an employer should designate someone who is qualified by appropriate training or experience to manage the complexity of the program. Training must occur before initial use of respiratory protection and at least annually thereafter, when changes in the workplace render previous training obsolete, or when inadequacies in an employee’s knowledge or use of the respirator indicate the employee has not retained the information or skills from the previous training.

While agencies can use contracted companies for services related to respiratory protection, an in-house and on-site program administrator must also be present. Outside companies may provide fit testing, medical evaluation, and other components of the RPP. Any contracted company should be carefully evaluated before enlisting their services.

The OSHA respiratory protection standard states that a physician or other licensed health care professional must perform the medical evaluation. This refers to a person whose legal scope of practice (that is holding a license, registration, or certification) allows him or her to independently provide a medical evaluation. If the evaluation questionnaire reveals a medical condition requiring further evaluation, the employee should be referred to a physician (M.D. or D.O. in Wisconsin) or practitioner whose scope of practice legally allows them this action. Generally, further evaluation is done by nurses, physician assistants, or other licensed health professionals working under M.D. or D.O. orders. As mentioned previously, agencies may contract a company to provide medical evaluations.

No, you do not need to be certified or have specific qualifications in order to perform fit testing. You should, however, receive training and become proficient in fit testing procedures.

OSHA does not allow employees to wear tight-fitting respirators if they have facial hair that comes between the sealing surface of the face piece and the face or if the hair interferes with valve function. Employees must either shave if they need to wear a tight-fitting respirator or they can use a loose-fitting PAPR, which does not require fit testing.

Resources

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Glossary

 
Last revised January 12, 2024