Respiratory protection — Healthcare

Scope

OSHA’s respiratory protection standard applies to General Industry employers who have employees exposed to hazards for which respiratory protection is required or used voluntarily (there are limited employer requirements for certain voluntary use).

Regulatory citations

• 29 CFR 1910.134 — Respiratory protection, and appendices (Appendix A — Fit Testing Procedures, Appendix B-1 — User Seal Check Procedures, Appendix B-2 — Respirator Cleaning Procedures, Appendix C — OSHA Respirator Medical Evaluation Questionnaire, and Appendix D — Information for Employees Using Respirators When not Required Under Standard.)

Key definitions

• Aerosol-generating procedures: Procedures that may increase potential exposure to aerosol transmissible disease pathogens due to the reasonably anticipated aerosolization of pathogens. Aerosol-generating procedures may also be known as high hazard or cough-inducing procedures.
• Aerosol transmissible disease (ATD) or aerosol transmissible disease pathogen: Any disease or pathogen requiring Airborne Precautions and/or Droplet Precautions.
• Airborne infection isolation room (AIIR): A single-occupancy patient-care room designed to isolate persons with suspected or confirmed airborne infectious diseases. Environmental factors are controlled in AIIRs to minimize the transmission of infectious agents that can be spread from person-to-person by the airborne route. AIIRs should maintain negative pressure relative to adjacent rooms and halls (so that air flows under the door gap into the room), an air flow rate of 6–12 air changes per hour, and direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter.
• Airborne precautions: A category of Transmission-Based Precautions that CDC and HICPAC may recommend when Standard Precautions alone are not sufficient to prevent the transmission of disease. When Airborne Precautions are required patients should be placed in airborne infection isolation rooms and healthcare personnel sharing patients’ airspaces should wear respirators.
• Air-purifying respirator: A respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air-purifying element.
• Assigned protection factor (APF): means the workplace level of respiratory protection that a respirator or class of respirators is expected to provide to employees when the employer implements a continuing, effective respiratory protection program.
• Atmosphere-supplying respirator: A respirator that supplies the respirator user with breathing air from a source independent of the ambient atmosphere, and includes SARs and SCBA units.
• Canister or cartridge: A container with a filter, sorbent, or catalyst, or combination of these items, which removes specific contaminants from the air passed through the container.
• Continuous flow respirator: An atmosphere-supplying respirator that provides a continuous flow of breathable air to the respirator facepiece.
• Demand respirator: An atmosphere-supplying respirator that admits breathing air to the facepiece only when a negative pressure is created inside the facepiece by inhalation.
• Droplet precautions: A category of Transmission-Based Precautions that CDC and HICPAC may recommend when Standard Precautions alone are not sufficient to prevent the transmission of disease. When Droplet Precautions are required, patients should be spatially separated, preferably in separate rooms with closed doors. Healthcare personnel should wear surgical masks for close contact and, if substantial spraying of body fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles). Patients should be masked during transport.
• Elastomeric: A respirator facepiece made of a natural or synthetic elastic material such as natural rubber, silicone, or synthetic rubber.
• Emergency situation: Any occurrence such as, but not limited to, equipment failure, rupture of containers, or failure of control equipment that may or does result in an uncontrolled significant release of an airborne contaminant.
• Employee exposure: Exposure to a concentration of an airborne contaminant that would occur if the employee were not using respiratory protection.
• End-of-service-life indicator (ESLI): A system that warns the respirator user of the approach of the end of adequate respiratory protection, for example, that the canister or cartridge sorbent is approaching saturation or is no longer effective.
• Escape-only respirator: A respirator intended to be used only for emergency exit.
• Filter or air-purifying element: A component used in respirators to remove solid or liquid aerosols from the inspired air.
• Filtering facepiece (or dust mask): A negative pressure particulate respirator with a filter as an integral part of the facepiece or with the entire facepiece composed of the filtering medium.
• Fit factor: A quantitative estimate of the fit of a particular respirator to a specific individual. It typically estimates the ratio of the concentration of a substance in ambient air to its concentration inside the respirator when worn.
• Fit test: The use of a protocol to qualitatively or quantitatively evaluate the fit of a tight-fitting respirator facepiece on an individual.
• Healthcare personnel (HCP): 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.
• High-efficiency particulate air filter (HEPA): A filter that is at least 99.97% efficient in removing monodispersed particles of 0.3 micrometers in diameter. The equivalent NIOSH 42 CFR 84 particulate filters are the N100, R100, and P100 filters.
• Hood: A respiratory inlet covering that completely covers the head and neck and may also cover portions of the shoulders and torso.
• Immediately dangerous to life or health (IDLH): An atmosphere that poses an immediate threat to life, would cause irreversible adverse health effects, or would impair an individual’s ability to escape from a dangerous atmosphere.
• Interior structural firefighting: The physical activity of fire suppression, rescue or both, inside of buildings or enclosed structures which are involved in a fire situation beyond the incipient stage. (See 29 CFR 1910.155).
• Loose-fitting facepiece: A respiratory inlet covering that is designed to form a partial seal with the face.
• Maximum use concentration (MUC): The maximum atmospheric concentration of a hazardous substance from which an employee can be expected to be protected when wearing a respirator, and is determined by the assigned protection factor of the respirator or class of respirators and the exposure limit of the hazardous substance. The MUC can be determined mathematically by multiplying the assigned protection factor specified for a respirator by the required OSHA permissible exposure limit, short-term exposure limit, or ceiling limit. When no OSHA exposure limit is available for a hazardous substance, an employer must determine an MUC on the basis of relevant available information and informed professional judgment.
• Negative pressure respirator (tight-fitting): A respirator in which the air pressure inside the facepiece is negative during inhalation with respect to the ambient air pressure outside the respirator.
• N95 filter: A type of NIOSH-approved filter or filter material, which captures at least 95% of airborne particles and is not resistant to oil.
• N95 respirator: A generally used term for a half mask air-purifying respirator with NIOSHapproved N95 particulate filters or filter material (i.e., includes N95 filtering facepiece respirator or equivalent protection).
• Oxygen deficient atmosphere: An atmosphere with an oxygen content below 19.5% by volume.
• Permissible Exposure Limit (PEL): An occupational exposure limit specified by OSHA.
• Physician or other licensed healthcare professional (PLHCP): An individual whose legally permitted scope of practice (i.e., license, registration, or certification) allows him or her to independently provide, or be delegated the responsibility to provide, some or all of the healthcare services required by paragraph (e) of the standard.
• Positive pressure respirator: A respirator in which the pressure inside the respiratory inlet covering exceeds the ambient air pressure outside the respirator.
• Powered air-purifying respirator (PAPR): An air-purifying respirator that uses a blower to force the ambient air through air-purifying elements to the inlet covering.
• Pressure demand respirator: A positive pressure atmosphere-supplying respirator that admits breathing air to the facepiece when the positive pressure is reduced inside the facepiece by inhalation.
• Qualitative fit test (QLFT): A pass/fail fit test to assess the adequacy of respirator fit that relies on the individual’s response to the test agent.
• Quantitative fit test (QNFT): An assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator.
• Recommended Exposure Limit (REL): An occupational exposure level recommended by NIOSH.
• Self-contained breathing apparatus (SCBA): An atmosphere-supplying respirator for which the breathing air source is designed to be carried by the user.
• Supplied-air respirator (or airline) respirator (SAR): An atmosphere-supplying respirator for which the source of breathing air is not designed to be carried by the user.
• Surgical mask: A loose-fitting, disposable type of facemask that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. Surgical masks are fluid resistant and provide protection from splashes, sprays, and splatter. Surgical masks do not seal tightly to the wearer’s face, do not provide the wearer with a reliable level of protection from inhaling smaller airborne particles, and are not considered respiratory protection.
• Surgical respirator: A filtering facepiece respirator with spray- or splash-resistant facemask material on the outside to protect the wearer from splashes. Also known as a surgical N95 respirator.
• Threshold Limit Value (TLV): An occupational exposure level recommended by ACGIH.
• Tight-fitting facepiece: A respiratory inlet covering that forms a complete seal with the face.
• User seal check: An action conducted by the respirator user to determine if the respirator is properly seated to the face.

Summary of requirements

Employers are required to:

• Identify and evaluate the respiratory hazard(s) in the workplace.
• Develop and implement a written respiratory protection program with required worksite-specific procedures and elements for required respirator use.
• Designate a program administrator to administer the respiratory protection program.
• Conduct evaluations of the workplace as necessary to ensure that the provisions of the current written program are being effectively implemented, and that it continues to be effective.
• Select and provide appropriate respirators.
• Train employees on respiratory protection.
• Provide a medical evaluation to determine the employee’s ability to use a respirator, including N95 (dust masks) if required to be used.
• Identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations.
• Fit-test employees initially and at least annually thereafter with the same make, model, style, and size of respirator that will be used. This applies to all tight-fitting respirators, including N95 (dust masks) if required to be used.
• Clean and disinfect respirators per OSHA requirements.
• Store all respirators to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals.
• Use compressed air, compressed oxygen, liquid air, and liquid oxygen for respiration that meets OSHA specifications.
• Retain records of medical evaluations required by 1910.134, AND make them available in accordance with 1910.1020.
• Establish a record of the qualitative and quantitative fit tests administered to an employee.
• Retain fit test records for respirator users until the next fit test is administered.
• Retain a written copy of the current respirator program.
• Provide any retained written materials, upon request, to affected employees and to OSHA or designee for examination and copying.
• Ensure any voluntary respirator use is done in a way that poses no hazards to the worker. Also provide a copy of Appendix D from the Respiratory Protection standard to all voluntary respirator users.