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.

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

Resources


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Last revised January 12, 2024