Infection Control and Prevention: Respiratory Protection

A PAPR is a powered, air-purifying respirator. It is a battery operated device that draws air through a filter to remove very small infectious agents such as TB bacteria. The air then flows into a hood that covers the wearer's head and face, and in this way, the user is able to breathe air that has only minimum or no infectious agents. PAPRs should be cleaned according to manufacturer's instructions to avoid damage to the units.

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.

An initial medical evaluation must be completed before the employee can wear a respirator and periodically thereafter as determined by the 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 medical advisor or respiratory protection program 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.

Yes, but an in-house, on-site program administrator must also be present. Agencies can use other companies to provide fit testing, medical evaluation, and other components of the respiratory protection program. Any contracting company should be carefully evaluated before enlisting their services.

All respirators that fit tightly on the face must be fit-tested (e.g. N-95 filtering face pieces, PAPRs with half or full face pieces). Those with loose-fitting face pieces do not need to be fit-tested.

Fit-testing must occur before an employee first uses a respirator, at least annually thereafter, before a different make or model of respirator is used, or when there are changes in an employee's physical condition that may affect the fit of the respirator (e.g. significant weight changes, changes in facial features).

Persons do not need to be certified or have specific qualifications in order to perform fit-testing. They should, however, receive training and become proficient in fit-testing procedures.

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.

Employers must keep records of medical evaluations and fit-testing procedures. Medical evaluations are part of the employee's medical record and as such must be kept for the period of employment plus 30 years. Information on access to employee exposure and medical records OSHA Standard 29 CFR 1910.1020.

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.