Introduction to Respiratory Protection

1
Introduction to Respiratory Protection
29 CFR 1910.134
2
Respiratory Hazards

• Particulates
• dusts
• fumes
• mists
• fibers
• Gases and Vapors
• Oxygen Deficiency
• The primary means to control respiratory hazards
  is through the use of control measures such as
  ventilation, enclosures, isolation, substitution
  of less toxic materials, or work practice
  modifications, and ppe.

3
Respiratory Tract
Naso-pharyngeal Region
Trachea Bronchi Bronchiole Terminal Bronchiole
Respiratory Bronchiole Alveolar Duct Alveolar S
ac
Tracheal-bronchial Region (conducting region)
Pulmonary Compartment (1/2 tennis court)
The major divisions of the respiratory tract
(adapted from J.B. West, Respiratory Physiology,
4th ed. Baltimore, MD Williams and Wilkins,
1990).
4
Droplet vs. Airborne Precautions

• Droplet Precautions Intended to prevent
  transmission of infectious agents
• spread through close respiratory or mucous
  membrane contact with respiratory
• secretions. In addition to standard precautions,
  droplet precautions
• require
• ?? MaskDon a mask upon entry into the patient
  room or cubicle.
• ?? Other areas addressed include patient
  placement and patient transport.
• Airborne Precautions Intended to prevent
  transmission of infectious
• agents that remain infectious over long
  distances when suspended in the
• air. In addition to standard precautions,
  airborne precautions require
• ?? Respiratory protection Wear a fit-tested
  NIOSH-approved N95 or
• higher level respirator for respiratory
  protection when entering the
• room or home of a patient who is suspected or
  confirmed to have an
• airborne infectious disease.
• ?? Other areas addressed include patient
  placement, patient transport,
• personnel restrictions, and exposure management

• SOURCE Siegel et al., 2007.

5
Medical (surgical) Masks vs. Respirators

• Medical masks (the term is used in this report to
  encompass
• surgical masks and procedure masks) are
  loose-fitting coverings
• of the nose and mouth designed to protect the
  patient from the cough or
• exhaled secretions of the physician, nurse, or
  other healthcare worker.
• Medical masks are not designed or certified to
  protect the wearer from
• exposure to airborne hazards. They may offer some
  limited, as yet
• largely undefined, protection as a barrier to
  splashes and large droplets.
• However, because of the loose-fitting design of
  medical masks and their
• lack of protective engineering, medical masks are
  not considered personal
• protective equipment.

6
Benefits of a Medical Mask

• Medical masks
• Readily available
• Inexpensive
• But does not provide respiratory protection and
  is not PPE

7
What is a Respirator?

• The term respirator is used in the healthcare
  field to refer to two different
• medical devices
• (1) the personal protective equipment discussed
  in this
• report that is used to reduce the wearers risk
  of inhaling hazardous
• substances and
• (2) the mechanical ventilator device that is used
  to maintain the patients
• Respiration following endotracheal intubation.
  This dual (medical and
• occupational) use of the term respirator has
  prompted many healthcare
• workers to refer to PPE respirators as masks,
  thereby confounding the
• important distinctions between medical masks and
  respirators.

8
What is a Respirator?

• Respirators are devices that protect workers
  from inhaling harmful airborne substances .
• Some respirators also ensure that workers do not
  breathe air that contains dangerously low levels
  of oxygen (O2).
• (OSHAs Small Entity Compliance Guide, 9/30/98)

9
What is a Respirator?

• Respirators are personal protective devices that
  cover the nose and mouth (or in some cases, more
  of the face and head) and are used to reduce the
  wearers risk of inhaling hazardous airborne
  particles. Respirators operate either by
  purifying the air inhaled by the wearer through
  filtering materials or by independently supplying
  breathable air to the wearer. The two major
  issues related to air-purifying respirators are
  the filter and the fitthe effectiveness of the
  filter and the extent to which the respirator has
  a tight seal with the wearers face that does not
  permit inward leakage.

10
Overview of Use Requirements

• To effectively wear most types of air-purifying
  respirators,
• prospective wearers must undergo annual fit
  testing (using
• Qualitative and/or quantitative tests), and they
  are asked to
• perform a fit check with each use of the device.

11
Benefits of a Respirator

• Respirators worn by healthcare workers not only
  will protect
• them, but also may reduce the spread of disease
  from one
• patient to another (via the healthcare worker) or
  from an
• infected but asymptomatic healthcare worker.

12
Respirator?

• Is a filtering face piece a respirator?
• How about a one-strap mask?
• How about a two-strap mask?
• What about a surgical mask? .
• Ever see a bandana used as a respirator - is it?

13
Two Classes of Respirators

• 1) Air-purifying respirators - respirators with
  an air-purifying filter, cartridge, or canister
  that remove specific air contaminants such as
  dusts, fumes, mists, vapors, or fibers by passing
  ambient air through an air-purifying element
• 2) Atmosphere-supplying respirators - provide
  clean breathing air from an uncontaminated source

14
Two Operational Modes

• 1) Negative Pressure - A respirator in which the
  air pressure inside the face piece is negative
  during inhalation with respect to the ambient air
  pressure outside the respirator.
• 2) Positive Pressure - A respirator in which the
  pressure inside the respirator exceeds the
  ambient air pressure outside the respirator.

15
Air Purifying Respirators

• Tight-fitting respirator
• Negative pressure
• Only for use against particles
• One of most common types used in industry

Dust Mask OSHA APF 10
16
Air Purifying Respirators

• Tight-fitting respirator
• Negative pressure
• Uses replaceable filters, canisters, or
  cartridges
• 2nd most common type

Half Mask OSHA APF 10
17
Powered Air-Purifying Respirator (PAPR)

• An air-purifying respirator that uses a blower
  to force the ambient air through air-purifying
  elements to the respirator
• Can be loose fitting or tight fitting
• Always positive pressure
• Continuous flow

OSHA APF 25 (loose fitting) OSHA APF 25/1000
(tight fitting)
18
Respirator Filter

• A component used in respirators to remove solid
  or liquid aerosols from the inspired air. Also
  called air purifying element.

19
Classes of Filters
42 CFR Part 84 establishes three series of
filters and each has three levels of efficiency.
?Levels of efficiency
95 99 100 N N95 N99 N100 R R95 R99 R100 P P95 P99
P100
Resistance?
20
Cartridge Change Schedule
A cartridge change schedule must be developed for
cartridges that do not have an end of service
life indicator
21
Selection of Respirators
The employer shall identify and evaluate the
respiratory hazard(s) including a reasonable
estimate of employee exposures and should
consider workplace and user factors that affect
respirator performance and reliability.
22
1910.134(c)(1) Respiratory protection program

• Where respirators are required you need
• Written program
• Worksite-specific procedures
• Required elements
• Training
• Fit testing
• Medical evaluations
• Care and maintenance
• Procedures for respirator selection
• Procedures for routine emergency use

23
(No Transcript)
24
Factors That Can Influence Respirator Selection

• Worker Medical Condition
• Wearing respiratory protection poses a physical
  burden on the wearer.
• When a worker's medical condition would prohibit
  restrictive breathing conditions, negative
  pressure respirators would not be an appropriate
  choice.
•  Worker Comfort
•  Worker preferences should be a consideration
  during the respirator selection process.
• Worker-Resident Communication and Perception

25

Employer Responsibilities

• Employers must designate a respirator program
  administrator, qualified by training or
  experience, to oversee the program
• Respirators, training, and medical evaluations
  must be provided at no cost

26
Written Respirator Program

• REQUIRED
• 1) When respirators are necessary due to air
  contaminant overexposure
• 2) When respirators are required by the employer

27
Respirator Use Not Required

• Employer may provide respirators at request of
  employees
• OR
• Allow employees to use their own respirator

28
Voluntary Respirator Use

• Employer must ensure that
• 1) Employees are medically able to use
  respirators
• 2) The respirator is cleaned, stored, and
  maintained properly
• 3) A written program addresses the two elements
  listed above
• 4) Employees are provided with information from
  Appendix D of the standard

29
Voluntary Respirator Use

• EXCEPTION Employers are not required to include
  in a written respirator program those employees
  whose only use of respirators involves the
  voluntary use of filtering facepieces (i.e. dust
  masks)

30
You Must Wear the Respirator Correctly! You will
not be protected if you don't wear your
respirator correctly. Follow the manufacturer's
instructions. For dust masks (also called
filtering facepieces or "N95" respirators) and
other half-facepiece respirators this means

• The respirator is properly positioned over your
  nose and mouth at all times
• The top strap or head harness assembly is
  positioned high on the back of the head
• The lower strap is worn at the back of the neck
  below the ears
• Nothing (beards, head coverings, etc.) passes
  between the skin of the face and the respirator's
  sealing edge.
• Do not take the respirator away from you nose or
  mouth until you reach clean air!  
• Properly worn respirator
  Improperly worn respirators            
                                      

Both straps must bepositioned correctly.
The nose and mouth mustbe covered at all times.
31
(No Transcript)
32
Respirator Fitting

• Applies Only to Respirators with
• Tight-fitting Facepieces

33
Respirator Fitting

• USER SEAL CHECK
• Positive
• Negative
• FIT TEST
• Qualitative
• Quantitative

34
User Seal Check

• The purpose of the user seal check is to
  subjectively assure that the there is an adequate
  seal of the face piece to the face of the wearer
• A user seal check must be performed each time
  the user puts on the respirator

35
Positive Pressure User Seal Check
36
Negative Pressure User Seal Check
37
Fit Test

• The main purpose of a fit test is to select the
  best fitting size and make of respirator within a
  pre-determined class for a specific individual

38
Fit Test

• Fit Tests must be performed
• 1) Prior to initial use
• 2) Whenever a different face piece is used
• 3) Annually
• 4) When changes in an employees physical
  condition occur
• 5) Employee indicates that fit is poor

39
Qualitative Fit Test

• Four Validated Methods
• Saccharine Solution Aerosol
• Bitrex Solution
• Isoamyl Acetate (Banana Oil)
• Irritant Smoke (Stannic Chloride)

40
Saccharine Solution Aerosol
41
Quantitative Fit Test

• Four Validated Methods
• Generated Aerosol System
• Ambient Aerosol System
• Controlled Negative Pressure System
• REDON

42
Ambient Aerosol System
43
Medical Evaluations

• 1) Must be provided before fit testing and
  before an employee is required to use a
  respirator
• 2) Must be performed by a physician or PLHCP
  using a medical questionnaire (from Appendix C of
  standard) or initial medical screening that
  obtains the same information
• 3) Follow-up exam provided if necessary, based
  on employees initial evaluation

44
Medical Evaluations
Two situations where medical evaluation is not
required

• Voluntary use of filtering facepieces (dust
  masks)
• Use of escape-only respirators

Note OSHAs expanded health standards contain
specific medical monitoring requirements.
45
Medical Evaluations

• Information provided to PLHCP
• a) type and weight of respirator
• b) duration and frequency of use
• c) expected work effort
• d) other protective equipment and clothing worn
• e) temperature and humidity extremes during use
• f) copy of written respirator program

46
Medical Evaluations

• Additional evaluations required if
• 1) employee reports medical problems related to
  respirator use
• 2) a PLHCP, supervisor, or program administrator
  indicates need for reevaluation
• 3) observations during fit testing, program
  evaluation, etc. indicate need
• 4) change in workplace conditions result in
  increase in physiologic burden

47
Respirator Maintenance and Care

• Maintain in sanitary condition
• Store to prevent damage or contamination
• Inspect before use and during cleaning
• Emergency use respirators inspected monthly
• Repairs done by trained person using parts from
  same manufacturer

48
Respiratory ProtectionResources

• http//www.osha.gov
• Slide Presentation
• Major Requirements for OSHAs Respiratory
  Protection Standard (PDF File)
• Respiratory Protection Frequently Asked Questions
• Respiratory Protection Standard (Correction)

49
Respiratory Protection Resources

• http//www.osha.gov
• Summary and Explanation of the Standard
• Respiratory Protection Final Rule
• Respiratory Protection Technical Advisor

50
Respiratory Protection 29 CFR
1910.134
Voluntary Use of Respirators
TYPE Facial Hair Fit Test App. C App. D Written Program
Filtering Face Piece (Dust Mask)
Elastomeric Face Piece
Yes
No
No
Yes
No
No
Yes
Yes
Yes
Yes
51
Respirator Review

• Is a filtering face piece a respirator?
• How about a one-strap mask?
• How about a two-strap mask?
• What about a surgical mask?
• How about a ½ mask elastomeric respirator?

52
New Items

• Respiratory Protection
• Occupational
• General Public
• What is the difference?????????

53
(No Transcript)
54
(No Transcript)