What's New in Respiratory Protection

Understanding the difference in respiratory protection and source control.

Millions of workers are required to wear respirators in various workplaces throughout the United States. Respirators protect workers against insufficient oxygen environments, harmful dusts, fogs, smokes, mists, gases, vapors, and sprays. These hazards may cause cancer, lung impairment, diseases, or death.

Compliance with the OSHA Respiratory Protection Standard could avert hundreds of deaths and thousands of illnesses annually. There are many challenges in the administration of a respiratory protection program. Each employer has his or her own unique concerns and needs depending on the industry, whether it be health care, general industry, construction, or emergency response.

Since the COVID-19 pandemic hit us hard over a year ago, we have been faced with PPE and respiratory protection shortages, fraudulent sales of PPE, and counterfeit filtering face-piece respirators. They have had a major impact on the healthcare industry. It is important when purchasing respiratory protection that validity of the paperwork is verified. A review of documents from companies based in China has found a significant amount of falsified documentation.

Many healthcare providers were forced to purchase KN95’s to provide respiratory protection for their healthcare providers only to find that they were unable to achieve an acceptably tight face seal for devices with ear loops. Such devices will not provide the expected level of protection against COVID-19 and other hazards. KN95 respirators with ear loops are not recommended for use in healthcare settings unless they are a last resort before downgrading protection to a medical face mask. In the battle to protect our workers we have been introduced to a new set of terminology: Respiratory Protection vs. Source Control. What is the difference? In layman’s terms, respiratory protection protects the wearer and source control protects others. Unlike respirators, masks are not designed to reduce the particles that the wearer will inhale and are not evaluated by NIOSH for their effectiveness to protect the wearer from airborne hazards. How effective are face coverings in terms of protection, fit, comfort, filtration, and safety?

To meet a gap in source control and respiratory protection, two important standards and certifications have just been released: the ASTM F3502-21 Standard Specification for Barrier Face Coverings and the NIOSH certification of the First Elastomeric Half Mask Respirator Without an Exhalation Valve.

ASTM F3502-21 Standard Specification for Barrier Face Coverings is primarily intended to help ensure barrier face coverings to meet the stated requirements to provide a means of source control for individual wearers by reducing the number of expelled droplets and aerosols from the wearer’s nose and mouth into the air and to potentially offer a degree of particulate filtration to reduce the amount of inhaled particulate matter by the wearer. The standard establishes minimum care, design, labeling, and performance requirements for reusable barrier face coverings.

Remember, respirator use must be in the context of a complete respiratory protection program in accordance with OSHA’s Respiratory Protection standard: 29 CFR 1910.134. All respirator users must be medically evaluated, trained and fit-tested.

To meet these concerns, OSHA states in 29 CFR 1910.134(c)(3) that:

“The employer shall designate a program administrator who is qualified by appropriate training or experience that is commensurate with the complexity of the program to administer or oversee the respiratory protection program and conduct the required evaluations of program effectiveness.”

Let us consider this statement, the employer shall designate a program administrator who is qualified by appropriate training or experience that is commensurate with the complexity of the program to administer or oversee the respiratory protection program and conduct the required evaluations of program effectiveness. It means key elements of an OSHA-compliant respiratory protection program must be customized based on hazard assessments of a specific workplace to prevent exposure from air contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, vapors, or sprays. Your programs need to be update if new challenges occur.

Our latest challenge is the 2019 Novel Coronavirus (2019-nCoV) or Patients Under Investigation for 2019-nCoV in Healthcare Settings.

Respiratory Protection CDC Review

  • Use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering face piece respirator before entry into the patient room or care area.
  • Disposable respirators should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator.
  • We need to stop referring to N-95 Respirators as Masks. They are Filtering Face-piece Respirators.
  •  If reusable respirators (e.g., powered air purifying respirator/PAPR) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
  • Respirator use must be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard. Staff should be medically cleared and fit-tested if using respirators with tight-fitting face pieces (e.g., a NIOSH-certified disposable N95) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use. Want to learn more about the respiratory protection standard? Can you reuse a N-95 respirator? Ever heard of Extended or Reuse of N-95 Respirators in Pandemic Planning?

According to OSHA’s Respiratory Protection Standard (29 CFR 1910.134), key elements are necessary for compliance. In my respiratory protection program, I have included eleven. They are:

  1. A written plan detailing how the program will be administered.
  2. The selection of respirators based on hazards that will be encountered in the job-specific workplace.
  3. A medical evaluation must be provided to determine an employee’s ability to use a respirator before fit testing and use.
  4. Fit testing must be provided to all employees using a negative or positive pressure respirator, and the respirators must pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) procedure.
  5. Respirators must be correctly used based on site-specific job hazards.
  6. Maintenance and care of respirators must be appropriate, based on the procedures in Appendix B-2, or equally effective or greater manufacturer’s procedures.
  7. Breathing air quality and use shall meet the requirements for Type 1-Grade D breathing air as described in ANSI/CGA Commodity Specification for Air, G-7.1-1989.
  8. All filters, cartridges, and canisters used in the workplace must be labeled and color-coded with the NIOSH approval label.
  9. Training and information must include:
  • Why the respirator is necessary. 
  • How improper fit, use, or maintenance can compromise the protective effect of the respirator. 
  • The limitations and capabilities of the respirator.
  • Proper use in emergency situations. 
  • How to inspect the respirator. 
  • Procedures for donning and doffing respirators. 
  • Seal checks. 
  • Procedures for maintenance and storage 
  • Recognition of medical signs and symptoms that may limit or prevent effective use of the general requirements of this standard.

      10. A Respiratory Protection Program Evaluation must conduct evaluations of the site-specific workplace as necessary to ensure proper implementation of the program and consult with employees to ensure proper use. 

  11. Record keeping. Records of medical evaluations must be retained and made available per 29 CFR 1910.1020. A record of fit tests must also be established and retained until the next fit test and a written copy of the current program must be retained.

    To meet these challenges, it is necessary that the program administrator is qualified based on the complexity of the specific site and job activities to be better prepared to administer or oversee the respiratory protection program and conduct the required evaluations of program effectiveness.

    This article originally appeared in the May 1, 2021 issue of Occupational Health & Safety.

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