Respiratory Protection Program Rice County Public Health Nursing Service September 2004

Transcription

1 Respiratory Protection Program Rice County Public Health Nursing Service September 2004 Purpose: This program is designed to protect the employees of the Rice County Public Health Nursing Service and their clients from the spread of communicable disease and to ensure the proper purchase, use, and maintenance of respiratory protection needed to ensure this protection. Applicable standards: The use of respirators is regulated by OSHA, which states that, when respirators are used for worker respiratory protection, a program that meets the requirements of 29CFR must be in place. Scope and application: This program applies to all employees of the Rice County Public Health Nursing Service who are required to wear a respirator during work operations. Most commonly this will be Public Health Nurses, but could also include other direct care providers such as Home Health Aides and others present on home visits, such as interpreters. Employees participating in this respiratory protection program do so at no cost to them. All expenses associated with required training, medical evaluations, and respiratory protection equipment will be borne by Rice County. The respirators in use by Rice County Public Health are the 3M N and 3M N , and they are for use in those situations that put employees at risk for inhalation of airborne infectious agents, including Mycobacterium tuberculosis, SARS-CoV, and other agents requiring use of N95 respiratory protection. Responsibilities 1. Program Administrator: The Program Administrator is responsible for administration of this Respiratory Protection Program. The Administrator will work with supervisory and Public Health Nurse staff to: Identify those work situations in which use of respiratory protection is needed Select appropriate respiratory protection equipment Monitor the use of respiratory equipment to ensure that it is used in accordance with their certifications Arrange for training Ensure proper storage and maintenance of respiratory protection equipment Conduct qualitative fit testing using sweet or bitter solutions from 3M Administer the medical evaluation program Maintain required records Evaluate the program

2 Update this written program as needed The Program Administrator for Rice County Public Health is the Public Health Director. 2. Supervisors: Supervisors are responsible for ensuring that the Respiratory Protection Program is implemented within their assigned areas of responsibility. In addition to being knowledgeable regarding the program requirements for their own protection, supervisors must also ensure that the program is understood and followed by the employees for whom they provide supervision. Supervisory duties include: Ensuring that employees that they supervise (including new hires) who are covered by this program receive appropriate training, fit testing, and medical evaluations. Ensuring the availability of appropriate respirators and accessories. Being aware of tasks requiring the use of respiratory protection. Ensuring employee adherence to all elements of this program. Ensuring that respirators are properly used, maintained, and stored according to the manufacturer s instructions and this plan. Ensuring that respirators fit well and do not cause discomfort. Monitoring work situations to identify those that pose respiratory hazards for employees. Coordinating with the Program Administrator regarding how to address respiratory hazards or other concerns regarding this program. 3. Employees: Each employee has the responsibility to wear her/his respirator when and where required and in the manner in which s/he was trained. Employees must also: Care for, maintain, and store respirators as instructed. Inform their supervisor if the respirator no longer fits well and request a new one that fits properly. Inform their supervisor or the Program Administrator of any respiratory hazards that they feel are not adequately addressed in the work environment and of any other concerns that they have regarding this program. Selection Procedures: In consultation with the Nursing Supervisors, the Program Administrator will select respirators to be used by the Rice County Public Health Nursing Service. This selection will be based upon a review of the respiratory hazards faced by Rice County Public Health employees and the applicable OSHA standards. Presently, respirator protection is needed when staff are providing care for persons with active or suspected respiratory Tuberculosis. The Agency also anticipates the possible need for respirator protection when caring for persons with actual, suspected, or probable infection with SARS-CoV.

3 The assessment of hazards is ongoing and respiratory protection equipment and training will be updated as needed. If an employee at any time believes that respiratory protection is needed during a particular activity, s/he is to contact her/his supervisor or the Public Health Director. The supervisor or Director will evaluate the potential hazard, obtaining outside consultation if necessary. The results of the assessment will be communicated to the employee and if respiratory protection is needed, all elements of this program will be in effect for those tasks and this program will be updated accordingly. All respirators used by Rice County Public Health Nursing Service employees must be certified by the National Institute for Occupational Safety and Health (NIOSH) and shall be used in accordance with the terms of the certification and the manufacturer s instructions. Also, all filters, cartridges, and canisters must be labeled with the appropriate NIOSH approval label, and this label must not be removed or defaced while the equipment is in use. This program does not provide for use of respirators in situations where it is not required by the employer or by OSHA. This is known as voluntary respirator use. Medical Evaluation: Rice County Public Health Nursing Service employees who are required to wear a respirator must pass a medical evaluation before being fit tested or permitted to wear a respirator on the job. Employees cannot be fit tested and are not permitted to wear respirators until a physician has determined that they are medically able to do so. Any employee refusing the medical evaluation will not be allowed to work in an area requiring respirator use. The medical evaluation will be conducted using the On-line Respirator Medical Questionnaire Service of the 3M Corporation. The program will be explained to participating staff ahead of time and staff will be given written materials and an opportunity to ask questions about the program. The 3M program includes the opportunity for employees to talk with the physician that is reviewing/has reviewed their medical questionnaire. In most instances, because of the very low volume of situations requiring respirator use in this Agency, those persons who do not receive medical clearance to use a respirator will simply not be assigned to care for persons that require respirator use; additional medical evaluation will not be pursued. If there is a need, persons who do not receive clearance will be provided with medical follow-up at no expense to the employee. In the event that internet connections are lost or a situation arises in which it is impossible to access the 3M program, the Agency will seek medical evaluation from Rice County s Community Health Services Medical Consultant. Attachment A at the end of this document is the evaluation form that will be used. All examinations and questionnaires are to remain confidential between the employee and the physician. Rice County Public Health will receive only the information indicating that the person has or has not been cleared to use the N95 respirator and the

4 Nursing Supervisors and Public Health Director will have this information so that appropriate work assignments can be made. After an employee has received clearance to wear an N95 mask, additional medical evaluations will be provided under the following circumstances: Employee reports signs and/or symptoms related to their ability to use a respirator, such as shortness of breath, dizziness, chest pains, or wheezing; Information from this program, including observations made during fit testing, program evaluation, or work situations, indicate a need for re-evaluation; A change occurs in workplace conditions that could result in an increased physiological burden on the employee. Fit Testing: Fit testing is required for all Rice County Public Health Nursing Service employees using the N95 respirator. These employees will be fit tested: Prior to being allowed to wear the N95 respirator; Annually; When there are changes in the employee s physical condition that could affect respiratory fit (e.g. obvious change in body weight, facial scarring, facial hair growth, etc.). Employees will be fit tested with the make, model, and size of respirator that they will actually wear and documentation will be maintained indicating who was tested, when, and using what equipment. Supervisors and the Public Health Director will have this information so that appropriate client care assignments can be made. All fit testing will be done by persons who have completed a program that qualifies them to do fit testing. Documentation of successful completion of this training will be kept on file by the Public Health Director. Fit testing will be conducted using the 3M Qualitative Fit Test Apparatus appropriate to the N95 mask being used. Respirator Use: Respiratory protection is required for employees providing Agency services to persons with known or suspected active infection with pulmonary Mycobacterium tuberculosis or actual, suspected, or probable infection with SARS-CoV. In most instances, this will be Public Health Nurses, but could also include Home Health Aides and persons such as interpreters that accompany staff on in-home client visits. General Use Procedures: Employees will use respirators under conditions specified by this program, and in accordance with the training they receive on the use of each particular model. In addition, the respirator shall not be used in a manner for which it is not certified by NIOSH or by its manufacturer. All employees shall conduct user seal checks (fit checks) each time that they wear their respirator. This can be the positive or negative pressure check, depending upon which works best for them. All employees shall be given the time needed to maintain their respirator in proper working order and shall report problems to their supervisor.

5 Employees are not permitted to wear tight-fitting respirators if they have any condition, such as facial scars, facial hair, or missing dentures, that prevents them from achieving a good seal. Employees are not permitted to wear jewelry or other articles that might interfere with the facepiece-to-face seal. In case of respirator malfunction, e.g. facepiece leakage, employees should inform their supervisor. The supervisor must ensure that the respirator is repaired or that the employee receives a new respirator. Maintenance, Change Schedules, and Storage: The 3M N95 respirators used by the Rice County Public Health Nursing Service can be used until damaged, breathing becomes difficult, or they are contaminated with blood or body fluids. The following will apply: No more than one employee can use any one mask. A different mask must be used for each individual client. If masks are to be used more than once and stored between uses, each will be kept in a paper bag (supply will be kept next to masks in supply cabinet) labeled with the name of the employee and, if necessary, a client name. Such masks should be kept in the individual employee s work area. Masks can be disposed of in client homes (household trash) or in the large hazardous waste tub located in the clinic room. Masks should be visually inspected before each use, checking for cleanliness and defects. Training: The Public Health Director and Nursing Supervisors will ensure that employees required to use respirators for work have received training prior to such use. All training will be done by persons who are also qualified to do fit testing. Nursing supervisors will receive training and fit testing on the N95 respirators used by the Rice County Public Health Nursing Service. Training will include the following: Contents of the Respiratory Protection Program OSHA Respiratory Protection Standard Respiratory hazards encountered in the workplace Respirators that have been selected for use at Rice County Public Health Limitations of respirators Respirator donning and user seal (fit) checks Fit testing Maintenance and storage Medical signs and symptoms limiting the effective use of respirators Employees who use respirators will be retrained annually and as needed. Part of the training will include employee demonstration of their understanding of the proper use of the N95 respirator. This will be done through oral feedback to the trainer and return demonstration of the employee s ability to properly wear the respirator and do a fit check. Respirator training will be documented by the trainer and maintained by the Public

6 Health Director. Documentation will include the type, model, and size of respirator for which each employee has been trained and fit tested. This information will be available to the Nursing Supervisors so that appropriate client assignments can be made. Program Evaluation: The Public Health Director and Nursing Supervisors will conduct periodic evaluations of the workplace to ensure that the provisions of this program are being implemented. This will include regular solicitation of feedback from employees that use respirators and a review of written documentation to be certain that it is up-todate and complete. All deficiencies noted will be addressed promptly, with target dates established for assessment of the problem and implementation of needed changes. The Respiratory Protection Program will also be reviewed annually and updated as needed. Documentation and Recordkeeping: A written copy of this program and the OSHA standard is kept in the office of the Public Health Director and in the file folder labeled Respiratory Protection Program and kept on the counter next to office mail boxes. These documents are available for all employees to review. Also in the Public Health Director s office are copies of training and fit test records and lists of employees that have received medical clearance to wear an N95 respirator. The Nursing Supervisors will have information concerning who has been cleared to wear a respirator and who has been fit tested, when, and on what equipment. These records will be updated on an ongoing basis; this includes when additional employees are trained, as currently trained employees receive refresher training, and as new fit tests are conducted. The only medical record that will be maintained by the Agency, in individual employee personnel records, is statement that the employee has or has not received clearance to wear a respirator.