Hospital Respiratory Protection Program Toolkit - Resources for Respirator Program Administrators Introduction to This Toolkit This toolkit was developed to assist hospitals in developing and implementing effective respiratory protection programs, with an emphasis on preventing the transmission of aerosol transmissible diseases (ATDs) to healthcare personnel. Healthcare personnel are paid and unpaid persons who provide patient care in a healthcare setting or support the delivery of healthcare by providing clerical, dietary, housekeeping, engineering, security, or maintenance services. Healthcare personnel may potentially be exposed to ATD pathogens. Aerosols are particles or droplets suspended in air. ATDs are diseases transmitted when infectious agents, which are suspended or present in particles or droplets, contact the mucous membranes or are inhaled. Hospitals are unique work environments with challenging occupational health and safety issues. Some hospitals have health and safety personnel who are highly qualified to develop and implement appropriate policies and procedures to control workplace exposures. However, in many facilities with more limited resources, the role of the health and safety professional might be taken on as an added responsibility by someone in the nursing, employee health, or infection control department. This toolkit is written as a practical manual that can be used by anyone charged with setting up and maintaining a hospital respiratory protection program. A respirator is a device worn over the nose and mouth to protect the wearer from hazardous materials in the breathing zone. Notice: This document was adapted from a California-specific guide, Implementing Respiratory Protection Programs in Hospitals: A Guide for Respirator Program Administrators, May 2012, which was developed by the California Department of Public Health, Occupational Health Branch, and the Public Health Institute under contract no. 254-2010-345-11 from the National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory (NIOSH-NPPTL). The guide was adapted under contract no. 254-2011-M-40839 from NIOSH-NPPTL to produce this toolkit. This guidance document is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and Health Act requires employers to comply with safety and health standards and regulations promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act's General Duty Clause, Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. * The version of this publication is as described above (this article is updated after each new edition). Disclaimer: "The use or appearance of United States federal publications, text, images or logos on a non-Federal Government website does not imply or constitute of endorsement of the distribution service."

This toolkit was developed to assist hospitals in developing and implementing effective respiratory protection programs, with an emphasis on preventing the transmission of aerosol transmissible diseases (ATDs) to healthcare personnel. Healthcare personnel are paid and unpaid persons who provide patient care in a healthcare setting or support the delivery of healthcare by providing clerical, dietary, housekeeping, engineering, security, or maintenance services. Healthcare personnel may potentially be exposed to ATD pathogens. Aerosols are particles or droplets suspended in air. ATDs are diseases transmitted when infectious agents, which are suspended or present in particles or droplets, contact the mucous membranes or are inhaled. This toolkit is written as a practical manual that can be used by anyone charged with setting up and maintaining a hospital respiratory protection program. This toolkit identifies existing public health guidance where available on the use of respiratory protection. Scientific evidence is continuously evolving, particularly with regard to disease transmission. Precautionary use of respiratory protection may be prudent where scientific uncertainty exists.

Hospital Respiratory Protection Program Toolkit - Resources for Respirator Program Administrators Introduction Unexpected releases of toxic, reactive, or flammable liquids and gases in processes involving highly hazardous chemicals have been reported for many years. Incidents continue to occur in various industries that use highly hazardous chemicals which may be toxic, reactive, flammable, or explosive, or may exhibit a combination of these properties. Regardless of the industry that uses these highly hazardous chemicals, there is a potential for an accidental release any time they are not properly controlled. This, in turn, creates the possibility of disaster. Recent major disasters include the 1984 Bhopal, India, incident resulting in more than 2,000 deaths; the October 1989 Phillips Petroleum Company, Pasadena, TX, incident resulting in 23 deaths and 132 injuries; the July 1990 BASF, Cincinnati, OH, incident resulting in 2 deaths, and the May 1991 IMC, Sterlington, LA, incident resulting in 8 deaths and 128 injuries. Although these major disasters involving highly hazardous chemicals drew national attention to the potential for major catastrophes, the public record is replete with information concerning many other less notable releases of highly hazardous chemicals. Hazardous chemical releases continue to pose a significant threat to employees and provide impetus, internationally and nationally, for authorities to develop or consider developing legislation and regulations to eliminate or minimize the potential for such events. Notice: This informational booklet is intended to provide a generic, non-exhaustive overview of a particular standards-related topic. This publication does not itself alter or determine compliance responsibilities, which are set forth in OSHA standards themselves and the Occupational Safety and Health Act. Moreover, because interpretations and enforcement policy may change over time, for additional guidance on OSHA compliance requirements, the reader should consult current and administrative interpretations and decisions by the Occupational Safety and Health Review Commission and the Courts. * The version of this publication is as described above (this article is updated after each new edition). Disclaimer: "The use or appearance of United States Federal publications, text, images or logos on a non-Federal Government website does not imply or constitute endorsement of the distribution service."

At least 16 different airborne infections have been associated with occupational transmission in health care workers. Respiratory protection is playing an increasing role in the protection of these workers. This study used a cross-sectional survey design to evaluate compliance with OSHA requirements for respiratory protection programs including respirator fit testing and to assess the knowledge and perceptions regarding respirator use and respiratory protection programs in healthcare facilities. Three groups participated in the survey: members of the Association of Professionals in Infection Control (APIC), safety/employee health administrators, and healthcare workers. Three anonymous surveys were administered to each group. Infection control, safety/employee health administrators, and healthcare workers differed in their perceptions regarding respirators. Safety/employee health administrators were more aware and supportive of respiratory protection but they also had gaps in knowledge. Both groups reported compliance with basic respiratory protection requirements but variable compliance with mandatory OSHA respirator program evaluation and fit testing procedure requirements such as employee selection of an acceptable respirator and allowing fit test subjects to try on respirators for one to five minutes. Survey respondents reported concerns regarding respirator costs, comfort and conflicting recommendations regarding respiratory protection. There was a lack of awareness of FDA approval requirements for respirators. Recommendations include the provision of more training and information regarding respiratory protection for infection control and hospital safety personnel. Future regulatory activity should focus on fitting characteristics of respirators. More research and evaluation of current respiratory protection practices in healthcare facilities is also recommended.