The Occupational Safety and Health Administration (“OSHA”) recognizes that the health care industry is among the most dangerous in the United States (see related story).  Health care employees are more likely to be exposed to various infectious respiratory illnesses spread through airborne and droplet routes, such as tuberculosis, influenza, and pandemics.  Employees who work in or near areas where there are patients suspected of having a disease that can be spread by airborne transmission should be using proper respiratory protection to minimize exposure of airborne diseases.

In March 2016, the National Institute for Occupational Safety and Health (“NIOSH”) published the results of a multi-year surveillance study examining the efficacy of respirator use in health care facilities where airborne transmission of diseases is likely.  The findings of the study are alarming – evidence collected during the study indicated gaps in hospitals’ respiratory protection policies and wide-spread failure by health care employees to use respirators correctly, even in hospitals with effective respiratory protection programs.  More specifically, the NIOSH study revealed that many employees were confused about when to use a respirator and how to properly use one and opted to simply use a surgical mask for protection instead.  But respirators and surgical masks are designed to protect against very different hazards.  Whereas a surgical mask protects patients from an employee’s respiratory secretions and protects employees against large-droplet splashes or spray of bodily fluids from patients, a respirator is designed to protect employees by providing a tight seal against the skin and filtering out a wide size range of airborne particles.

The study also found that a number of employees wore ill-fitting respirators.  To be effective, the wearer of a respirator must wear one that minimizes air leakage into the facepiece.  OSHA regulations require respirator fit testing before an employee is permitted to wear a respirator.  Because the fit of a respirator depends on a number of different factors, such as face shape, employers should provide a variety of models and sizes to try during the fit testing process.  Fit testing must be repeated annually, when a different respirator must be used, and where there has been a change in the employee’s facial structure such as extreme weight loss or dental work.

Finally, about 50% of the hospitals studied were deemed to have ineffective respiratory protection programs.  But even where good programs were in place, many employees used improper practices, including improper strap placement, failing to perform a user seal check, and improper donning and doffing of the respirator.

So how can health care employers correct this issue before tuberculosis or the next pandemic hits?  Employers should ensure that:

• their current respiratory protection policy is compliant with OSHA regulations, CDC guidance, and any additional public health requirements in their jurisdiction;

• all employees working in areas where they may exposed to airborne illnesses have been timely fit-tested for a respirator and understand how and when to use it;

• training on respirator use, fit, and how to properly don and doff the respirator has been provided and periodic refresher training scheduled;

• employees check their respirators regularly and know to immediately report to management should the respirator begin to deteriorate, fail to function properly, or no longer fit well; and

• employees receive new fit tests and respirators as needed.

These simple steps will help ensure the health and safety of employees and patients when the next airborne infectious disease infects your hospital.