ENVIRONMENTAL HEALTH & SAFETY WFBMC RESPIRATORY PROTECTION PROGRAM. Approved by: Effective Date: February 23, 2010 David A. Brown,

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1 ENVIRONMENTAL HEALTH & SAFETY WFBMC RESPIRATORY PROTECTION PROGRAM Approved by: Effective Date: February 23, 2010 David A. Brown, Revised Date: December, 2012 Co-Director, EH&S Feodor Bijkersma, Co- Director, EH&S I. INTRODUCTION II. REGULATORY OVERVIEW III. DEFINITIONS IV. ROLES AND RESPONSIBILITIES V. MEDICAL EVALUATION VI. RESPIRATORY USE CRITERIA/PROTOCOL A. RESPIRATOR HAZARD DETERMINATION B. RESPIRATOR SELECTION C. MAXIMUM USE CONCENTRATION D. USING RESPIRATORS WHEN T REQUIRED (VOLUNTARY USE) E. FIT TEST PROCEDURES F. RESPIRATOR USE UNDER SPECIAL CONDITIONS G. PROPER USE PROCEDURES H. RESPIRATOR EFFECTIVENESS I. ASSIGNED PROTECTION FACTORS J. END OF SERVICE LIFE INDICATOR (ESLI) K. INSPECTION L. CLEANING AND DISINFECTING M. STORAGE N. REPAIRS O. DISCARDING OF RESPIRATORS VII. TRAINING VIII. RECORD KEEPING IX. PROGRAM EVALUATION AND REVIEW X. APPENDICES A. RESPIRATOR INFORMATION FOR MEDICAL CLEARANCE B. MEDICAL QUESTIONNAIRE 1. INITIAL 2. ANNUAL C. PLHCP (WFBMC EMPLOYEE HEALTH SERVICES) FORMS 1. PLHCP RECOMMENDATION TO EH&S/NCBH SAFETY DEPARTMENT 2. PLHCP RECOMMENDATION TO EMPLOYEE D. RESPIRATORY HAZARD ASSESSMENT FORM E. RESPIRATOR USAGE AND SELECTION F. RESPIRATOR USERS G. USING RESPIRATOR WHEN T REQUIRED (VOLUNTARY USE) H. FIT TESTING PROTOCOLS 1

2 1. QUALITATIVE FIT TEST CHECKLIST 2. QUANTITATIVE FIT TEST CHECKLIST 3. RAINBOW PASSAGE 4. FIT TEST RECORD FORM I. USER SEAL CHECK PROCEDURES J. RESPIRATOR CLEANING PROCEDURES K. MONTHLY INSPECTION CARD FOR EMERGENCY RESPIRATORS (SCBA) L. TRAINING FORM M. RESPIRATORY PROTECTION PROGRAM EVALUATION CHECKLIST N. RESPIRATORY PROTECTION FLOW CHART (WFBMC) 1. INITIAL 2. ANNUAL O. RESPIRATORY PROTECTION FLOW CHART (NCBH) INTRODUCTION POLICY This policy is for Wake Forest Baptist Medical Center (WFBMC) Employees. Respirators shall be used where respiratory protection cannot be achieved through the use of engineering controls or appropriate infection control interventions. PURPOSE This Respiratory Protection Program functions to protect specified employees from respiratory hazards including tuberculosis (TB) and other communicable diseases. This Respiratory Protection Program governs the use of respiratory protection in the workplace. Respirators are to be used only where engineering and work practice controls of respiratory hazards are not feasible or fully effective, while engineering controls are being installed, potential exposure to tuberculosis and/or and other communicable diseases or in emergencies. TB AND OTHER COMMUNICABLE DISEASES All health care workers providing direct patient care to or entering rooms in which patients with suspected or confirmed TB disease or other communicable diseases are being isolated. All health care workers present during cough-inducing or aerosol-generating procedures performed on patients with suspected or confirmed infectious TB disease or other communicable diseases. Employees in other settings in which administrative and environmental controls will not protect them from inhaling infectious airborne droplet nuclei. Refer to the Transmission Based Isolation Precautions, NCBH 117 Standard/Transmission Based Isolation Precautions and PPB-NCBH-IC-36 Infection Control Emerging Communicable Diseases. SCOPE The requirements of this program apply to the use of all respirators for WFBMC Employees. 2

3 REGULATORY OVERVIEW DEFINITIONS OSHA 29 CFR Respiratory Protection Program Standard ANSI/AIHA Z American National Standard for Respiratory Protection Respirator use Physical Qualifications for Personnel ANSI/ AIHA Z American National Standard for Respirator Fit Testing Methods ANSI/ AIHA Z American National Standard for Color Coding of Air- Purifying Respirator Canisters, Cartridges and Filters NIOSH Publication No. Contact Lens Use in a Chemical Environment : Current Intelligence Bulletin 59 NIOSH Publication No. NIOSH Respirator Selection Logic : NIOSH Respirator Selection Logic 2004 NIOSH 42 CFR 84 Approval of respiratory protective devices NCBH Standard and Standard/Transmission Based Isolation Precautions Transmission Based Isolation Precautions, NCBH Guidelines for Preventing CDC / NIOSH Guidelines for Preventing the transmission the Transmission of of Mycobacterium Tuberculosis in a Health-Care Mycobacterium Settings, 2005 Tuberculosis in a Health- Care Settings, 2005 PPB-NCBH-IC-36 Infection Control Emerging Communicable Disease PPB-NCBH-IC-36 Infection Control Emerging Communicable Disease 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). 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 as specified by this section. Atmosphere-supplying respirator. A respirator that supplies the respirator user with breathing air from a source independent of the ambient atmosphere, and includes supplied-air respirators (SARs) and selfcontained breathing apparatus (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. Demand respirator. An atmosphere-supplying respirator that admits breathing air to the facepiece only 3

4 when a negative pressure is created inside the facepiece by inhalation. 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 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 (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, and 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 respirator on an individual. (See also Qualitative fit test QLFT and Quantitative fit test QNFT.) Helmet. A rigid respiratory inlet covering that also provides head protection against impact and penetration. High Efficiency Particulate Air (HEPA) filter. A filter that is at least 99.97% efficient in removing monodisperse 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) means 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. 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, 4

5 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. Oxygen deficient atmosphere. An atmosphere with an oxygen content below 19.5% by volume. Physician or other Licensed Health Care 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 health care services required by paragraph (e) of this section. 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. Respiratory inlet covering means that portion of a respirator that forms the protective barrier between the user's respiratory tract and an air-purifying device or breathing air source, or both. It may be a facepiece, helmet, hood, suit, or a mouthpiece respirator with nose clamp. Self-Contained Breathing Apparatus (SCBA). An atmosphere-supplying respirator for which the breathing air source is designed to be carried by the user. Service life means the period of time that a respirator, filter or sorbent or other respiratory equipment provides adequate protection to the wearer. Supplied-Air Respirator (SAR) or airline respirator. An atmosphere-supplying respirator for which the source of breathing air is not designed to be carried by the user. 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. 5

6 ROLES AND RESPONSIBILITIES ENVIRONMENTAL HEALTH AND SAFETY (EH&S) Maintain and administer the Respiratory Protection Program. Appoint the WFBMC Program Administrator for the Respiratory Protection Program Conduct Respiratory Hazard Assessments Recommend NIOSH Approved respirators. Provide the following information to WFBMC Employee Health (PLHCP) making a recommendation concerning an employee's ability to use a respirator: o The type and weight of the respirator to be used by the employee. o The duration and frequency of respirator use (including use for rescue and escape). o The expected physical work effort. o Additional protective clothing and equipment to be worn. o o o Temperature and humidity extremes that may be encountered. Any supplemental information provided previously to the PLHCP regarding an employee need not be provided for a subsequent medical evaluation if the information and the PLHCP remain the same. A copy of the written respiratory protection program and a copy of the OSHA Respiratory Protection Standard. Provide initial and annual respirator training and fit testing for smaller/specialized departments, Engineering, Animal Resource Program personnel; and off-site clinics. Annual evaluation and review of the Respiratory Protection Program. WFBMC EMPLOYEE HEALTH SERVICES Identify the Physician or other licensed health care professional (PLCHLP) to provide and perform all of the health care services required by 29 CFR , Respiratory Protection (listed below). o Provide an initial medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The medical evaluation shall be obtained using the questionnaire in APPENDIX B1, INITIAL MEDICAL QUESTIONNAIRE. o Provide follow-up medical examination for an employee who gives a positive response to any question among questions 1 through 8 in Section 2, Part A of APPENDIX B1 or whose initial medical examination demonstrates the need for a follow-up medical examination. The follow-up medical examination shall include any medical tests, consultations, or diagnostic procedures that are deemed necessary to make a final determination. o Provide an annual medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The medical evaluation shall be obtained using the questionnaire in APPENDIX B2, ANNUAL MEDICAL QUESTIONNAIRE. Administer the medical questionnaire and examinations confidentially during the employee's normal working hours or at a time and place convenient to the employee. The medical questionnaire shall be administered in a manner that ensures that the employee understands its content. Provide the employee with an opportunity to discuss the questionnaire and examination results. Inform Environmental Health and Safety (EH&S) on whether the employee can be fit test within 15 days by returning the PLHCP Recommendation to EH&S, APPENDIX C1. Inform the employee of his/her recommendations by sending the PLHCP Recommendation to Employee Form, APPENDIX C2. Perform initial and annual fit testing for all WFBMC staff, except those groups designated by EH&S 6

7 PRINCIPAL INVESTIGATOR/ MANAGER/SUPERVISOR Ensure that employees who have been issued respirators, use and maintain their respirator in the manner specified in the Respiratory Protection Program. Schedule employee to Employee Health Services for medical clearance. Conduct periodic monitoring to ensure respirator(s) is/are being worn properly. Ensure that employees using respirators are properly trained. Ensure that employees using respirators received medical clearance from WFBMC Employee Health Services. ALL FACULTY AND STAFF/EMPLOYEES Use NIOSH Approved respiratory equipment only. Attend annual fit testing and training. Use respiratory protection equipment in accordance with the Respiratory Protection Program. Inspect, clean, and maintain respiratory protective equipment. CONTRACTORS Obtain copy of contractor(s) Respiratory Program. Obtain a copy of training and fit testing and Medical Clearance. Ensure that all contractor personnel use respiratory equipment appropriate to the exposures encountered. MEDICAL EVALUATION A medical evaluation to determine whether an employee is able to use a given respirator is an important element of the WFBMC Respiratory Protection Program and is necessary to prevent injuries, illnesses, and even, in rare cases, death from the physiological burden imposed by respirator use. WFBMC will provide a medical evaluation free of charge through WFBMC Employee Health Services to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The EH&S Program Administrator will complete the form, Respirator Information for Medical Clearance, APPENDIX A for either an individual or a group of similar individuals. The completed Respirator Information for Medical Clearance Form will be sent to WFBMC Employee Health or other designated PLCHLP. This Form will assist the PLCHLP for making the following recommendations: The type and weight of the respirator to be used by the employee. The duration and frequency of respirator use (including use for rescue and escape). The expected physical work effort. Additional protective clothing and equipment to be worn. Temperature and humidity extremes that may be encountered. An initial medical questionnaire using the INITIAL MEDICAL QUESTIONNAIRE IN APPENDIX B1 will be completed by the employee and reviewed by WFBMC Employee Health Services. Employees will be provided an annual medical evaluation to determine the employee's ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The 7

8 medical evaluation shall be obtained using the questionnaire in APPENDIX B2, ANNUAL MEDICAL QUESTIONNAIRE. WFBMC Employee Health Services or other designated PLCHLP will inform Environmental Health and Safety (EH&S) owhether the employee can be fit test within 15 days by returning the PLCHP Recommendation Form, APPENDIX C1. WFBMC Employee Health Services or other designated PLCHLP will inform the employee of his/her recommendations using the form located in APPENDIX C2. RESPIRATORY USE CRITERIA/PROTOCOL RESPIRATORY HAZARD DETERMINATION EH&S shall perform respiratory hazard determinations using the RESPIRATORY HAZARD DETERMINATION FORM, APPENDIX D on the identified respiratory hazard(s) in the areas throughout WFBMC. This evaluation will include a reasonable estimate of employee exposures to respiratory hazard(s) and an identification of the contaminant's chemical state and physical form. Where WFBMC cannot identify or reasonably estimate the employee exposure, EH&S shall consider the atmosphere to be IDLH. RESPIRATOR SELECTION WFBMC will select and provide an appropriate respirator based on the respiratory hazard(s) identified by a respiratory hazard determination APPENDIX E to which the employee is exposed and area and user factors that affect respirator performance and reliability. WFBMC employees will select respirators from a sufficient number of respirator models and sizes so that the respirator is acceptable to and correctly fits the user. The respirators offered will be NIOSH-certified and used in compliance with the conditions of its certification. The Respirator Usage and Selection and the Respirator Users charts are located in APPENIDX F and G. MAXIMUM USE CONCENTRATION (MUC) WFBMC will select respirators for employee use that maintains the employee's exposure to the hazardous substance, when measured outside the respirator, at or below the MUC. WFBMC will not apply MUCs to conditions that are immediately dangerous to life or health (IDLH); instead, SCBAs will be used for IDLH conditions. When the calculated MUC exceeds the IDLH level for a hazardous substance, or the performance limits of the cartridge, then WFBMC must set the maximum MUC at that lower limit. The respirator selected will be appropriate for the chemical state and physical form of the contaminant. For protection against gases and vapors, WFBMC will provide: An atmosphere-supplying respirator or an air-purifying respirator, provided that: 8

9 o o The respirator is equipped with an end-of-service-life indicator (ESLI) certified by NIOSH for the contaminant; or If there is no ESLI appropriate for conditions in the workplace, WFBMC will implement a change schedule for canisters and cartridges that is based on objective information or data that will ensure that canisters and cartridges are changed before the end of their service life. WFBMC will describe in the respirator program the information and data relied upon and the basis for the canister and cartridge change schedule and the basis for reliance on the data. For protection against particulates, WFBMC will provide: An atmosphere-supplying respirator or an air-purifying respirator equipped with a filter certified for particulates by NIOSH under 42 CFR part 84 or For contaminants consisting primarily of particles with mass median aerodynamic diameters (MMAD) of at least 2 micrometers, an air-purifying respirator equipped with any filter certified for particulates by NIOSH. USING RESPIRATORS WHEN T REQUIRED (VOLUNTARY USE) Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for employees. However, if a respirator is improperly used or maintained, the respirator itself can become a hazard to the worker. Sometimes, employees may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. WFBMC will provide filtering facepiece respirators for voluntary use or employees can provide their own respirator, certain precautions must be taken to ensure that the respirator itself does not present a hazard. An employee who chooses to wear a respirator voluntarily should do the following: Read the information contained in APPENIDIX H Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will state what the respirator is designed for and how much it will protect you. Do not wear a respirator into atmospheres containing contaminants for which the respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke. Keep track of your respirator so that you do not mistakenly use someone else's respirator. Medical Clearance* will be required for voluntary respirator users to determine their ability to use the specified respirator safely, and that the respirator is cleaned, stored, and maintained so that its use does not present a health hazard to the user. 9

10 *Exception: Employees who only use of respirators involves the voluntary use of filtering facepieces (dust masks) will not have to be medically cleared. FIT TEST PROCEDURES It is imperative that respirators fit properly to provide protection. If a tight seal is not maintained between the face piece and the employee's face, contaminated air will be drawn into the facepiece and be breathed by the employee. Fit testing seeks to protect the employee against breathing contaminated ambient air. Before an employee can wear any respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used. WFBMC will ensure that employees using a tight-fitting facepiece respirator pass an appropriate qualitative fit test (QLFT) (APPENDIX H1) or quantitative fit test (QNFT) (APPENDIX H2). WFBMC will ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used and annually. WFBMC will conduct an additional fit test whenever the employee reports, or the PLHCP, supervisor, or program administrator makes visual observations of, changes in the employee's physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight, approximately 10 pounds. If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program administrator, supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall be given a reasonable opportunity to select a different respirator facepiece and to be retested. The fit test shall be administered using an OSHA-accepted QLFT or QNFT protocol as contained in APPENDIX H1 and H2. Any modifications to the respirator facepiece for fit testing shall be completely removed, and the facepiece restored to NIOSH-approved configuration, before that facepiece can be used in the workplace. Fit testing of tight-fitting atmosphere-supplying respirators and tight-fitting powered air-purifying respirators shall be accomplished by performing quantitative or qualitative fit testing in the negative pressure mode, regardless of the mode of operation (negative or positive pressure) that is used for respiratory protection. Qualitative fit testing of these respirators shall be accomplished by temporarily converting the respirator user's actual facepiece into a negative pressure respirator with appropriate filters, or by using an identical negative pressure air-purifying respirator facepiece with the same sealing surfaces as a surrogate for the atmosphere-supplying or powered air-purifying respirator facepiece. Quantitative fit testing of these respirators shall be accomplished by modifying the facepiece to allow sampling inside the facepiece in the breathing zone of the user, midway between the nose and mouth. 10

11 ACCEPTABLE FIT-TESTING METHODS QLFT QNFT Fit Factor (FF) Half-Face, Negative Pressure, APR Yes Yes <100 Full-Face, Negative Pressure, APR used in atmospheres up to 10 times the PEL Yes Yes <100 Full-Face, Negative Pressure, APR No Yes 100 PAPR Yes Yes N/A Supplied-Air Respirators (SAR), or SCBA used in Positive Pressure (Pressure Demand Mode) Yes Yes 500 SCBA/SAR - IDLH, Positive Pressure Yes Yes 500 Once the fit testing is complete, APPENDIX H4, FIT TESTING RECORD FORM will be completed by the employee being fit tested and the fit tester. RESPIRATOR USE UNDER SPECIAL CONDITIONS FACIAL HAIR Facial hair that lies along the sealing area of the respirator, such as beards, sideburns, moustaches or even a few days growth of stubble, should not be permitted on employees who are required to wear respirators that rely on a tight facepiece fit to achieve maximum protection. Facial hair between the wearer s skin and the sealing surfaces of the respirator will prevent a good seal. A respirator that permits negative air pressure inside the facepiece during inhalation may allow leakage and in the case of positive pressure devices, will either reduce service time or waste breathing air. A worker should not enter a contaminated work area when conditions prevent a good seal of the respirator facepiece to the face. EYE GLASSES Ordinary eye glasses should not be used with full facepiece respirators. Eye glasses with temple bars or straps that pass between the sealing surface of a full facepiece and the worker s face will prevent a good seal and should not be used. Special corrective lenses can be mounted inside a full facepiece respirator and are available from manufacturers of full facepiece respriators. To ensure good vision, comfort and proper sealing of the facepiece, these corrective lenses should not be mounted by an individual designated by the manufacturer as qualified to install accessory items. Eye glasses or goggles may interfere with the half face pieces. When interference occurs, a full facepiece with special corrective lenses should be provided and worn. CONTACT LENS Several factors may restrict or even prohibit the use of contact lenses while wearing any type of respiratory device. This is especially true of atmosphere-supplying respirators. With full-facepieces, incoming air directed toward the eye can cause discomfort from dirt, lint or other debris lodging between the contact lens and the pupil. 11

12 PROPER USE PROCEDURES Once the respirator has been properly selected and fitted, its protection efficiency must be maintained by proper use requirements including: Prohibiting conditions that may result in facepiece seal leakage. o Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function. o Any condition that interferes with the face-to-facepiece seal or valve function. Preventing employees from removing respirators in hazardous environments. Taking actions to ensure continued effective respirator operation throughout the work shift. Establishing procedures for the use of respirators in IDLH atmospheres. Wearing corrective glasses or goggles or other personal protective equipment, WFBMC will ensure that such equipment is worn in a manner that does not interfere with the seal of the facepiece to the face of the user. For all tight-fitting respirators, the WFBMC shall ensure that employees perform a user seal check each time they put on the respirator using the procedures in APPENDIX I or procedures recommended by the respirator manufacturer that the employer demonstrates are as effective as those in APPENDIX I. RESPIRATOR EFFECTIVENESS Appropriate surveillance shall be maintained of work area conditions and degree of employee exposure or stress. When there is a change in work area conditions or degree of employee exposure or stress that may affect respirator effectiveness, WFBMC will reevaluate the continued effectiveness of the respirator. WFBMC supervisors will ensure that employees leave the respirator use area: To wash their faces and respirator facepieces as necessary to prevent eye or skin irritation associated with respirator use If they detect vapor or gas breakthrough, changes in breathing resistance Leakage of the facepiece To replace the respirator or the filter, cartridge, or canister elements If the employee detects vapor or gas breakthrough, changes in breathing resistance, or leakage of the facepiece, WFBMC must replace or repair the respirator before allowing the employee to return to the work area. 12

13 ASSSIGNED PROTECTION FACTORS ASSIGNED PROTECTION FACTORS 5 TYPE OF RESPIRATOR 1, 2 HALF FULL HELMET/ LOOSE-FITTING MASK FACEPIECE HOOD FACEPIECE Air-Purifying Respirator Powered Air-Purifying Respirator (PAPR) 50 1, /1, Supplied-Air Respirator (SAR) or Airline Respirator Demand mode Continuous flow mode Pressure-demand or other positive-pressure mode Self-Contained Breathing Apparatus (SCBA) Demand mode Pressure-demand or other positive-pressure mode (e.g., open/closed circuit) ,000 1, , /1, , Notes: 1 Employers may select respirators assigned for use in higher workplace concentrations of a hazardous substance for use at lower concentrations of that substance, or when required respirator use is independent of concentration. 2 The assigned protection factors in Table 1 are only effective when the employer implements a continuing, effective respirator program as required by this section (29 CFR ), including training, fit testing, maintenance, and use requirements. 3 This APF category includes filtering facepieces, and half masks with elastomeric facepieces. 4 The employer must have evidence provided by the respirator manufacturer that testing of these respirators demonstrates performance at a level of protection of 1,000 or greater to receive an APF of 1,000. This level of performance can best be demonstrated by performing a WPF or SWPF study or equivalent testing. Absent such testing, all other PAPRs and SARs with helmets/hoods are to be treated as loose-fitting facepiece respirators, and receive an APF of These APFs do not apply to respirators used solely for escape. For escape respirators used in association with specific substances covered by 29 CFR 1910 subpart Z, employers must refer to the appropriate substance-specific standards in that subpart. Escape respirators for other IDLH atmospheres are specified by 29 CFR (d)(2)(ii). END OF SERVICE LIFE INDICATOR (ESLI) An end of service life indicator (ESLI) is a system that warns the respirator user of the approach of the end of adequate respirator protection. TYPE OF RESPIRATOR N-95 for TB & Other Communicable Diseases N-95 Technol used in ARP Areas NCBH117 ESLI Up to 8 hours if not wet, crushed, contaminated or damaged and no affect toward the seal. 13

14 TYPE OF RESPIRATOR ESLI N-100 Up to 4 hours if not wet, crushed, contaminated or damaged and no affect toward the seal. Particulate cartridges Clogging or resistant to breath increases which will be monthly or as needed. Chemical cartridges Taste, irritation or odor indicates the end of service life which will be monthly or as listed below. CHEMICAL Acrylonitrile Benzene Butadiene Formaldehyde Vinyl chloride Methylene chloride ESLI End-of-service life or end of shift (whichever occurs first) End-of-service life or beginning of shift (whichever occurs first) Every 1, 2 or 4 hours dependent on concentration according to Table 1 and at beginning of each shift For cartridges every three hours or end of shift (whichever is sooner) End-of-service life or end of shift in which they are first used (whichever occurs first) Canisters may only be used for emergency escape and must be replaced after use. Proper cartridges shall be used. The label must be legible - if the label is unreadable, then replace cartridges with new, proper cartridges. Respirators cannot be modified or one cannot interchange cartridges with other manufacturers cartridges. The same type of cartridge must be used on both sides of the respirator. INSPECTION In order to assure the continued reliability of respirator equipment, it must be inspected on a regular basis. The frequency of inspection is related to the frequency of use. Here are our frequencies for inspection: RESPIRATOR TYPE Issued for the exclusive use of an employee All types used in routine situations Maintained for use in emergency situations Emergency escape-only respirators INSPECTED AT THE FOLLOWING FREQUENCIES As often as necessary to be maintained in a sanitary condition Before each use and during cleaning At least monthly and in accordance with the manufacturer's recommendations, and checked for proper function before and after each use (APPENDIX K ) Before being carried into the workplace for use Respirator inspections include a check: For respirator function, tightness of connections, and the condition of the various parts including, but not limited to, the facepiece, head straps, valves, connecting tube, and cartridges, canisters or filters Of elastomeric parts for pliability and signs of deterioration. 14

15 CLEANING AND DISINFECTING WFBMC will provide each respirator user with a respirator that is clean, sanitary, and in good working order. All respirators are cleaned and disinfected using the procedures below and in Appendix J. Respirators are cleaned and disinfected at the following intervals: RESPIRATOR TYPE Issued for the exclusive use of an employee Issued to more than one employee Maintained for emergency Use Used in fit testing and training CLEAN AND DISINFECT AT THE FOLLOWING INTERVAL As often as necessary to be maintained in a sanitary condition Before being worn by different individuals After each use After each use STORAGE Respirators must be stored properly to ensure that the equipment is protected and not subject to environmental conditions that may cause deterioration. Respirators shall be stored to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals. Packed, or stored, to prevent deformation of the facepiece and exhalation valve. Respirators may be stored in a clean sealable Ziploc plastic bag and then place in the manufacturer s box. In addition, emergency respirators to be kept accessible to the work area; stored in areas that are clearly marked as containing emergency respirators; and stored in accordance with any applicable manufacturer instructions. REPAIRS Respirators that fail an inspection or are otherwise found to be defective are removed from service, and are discarded or repaired or adjusted in accordance with the following procedures: Repairs or adjustments to respirators are to be made only by persons appropriately trained to perform such operations and only with the respirator manufacturer's NIOSH-approved parts designed for the respirator. Repairs must be made according to the manufacturer's recommendations and specifications for the type and extent of repairs to be performed. Reducing and admission valves, regulators, and alarms must be adjusted or repaired only by the manufacturer or a technician trained by the manufacturer. DISCARDING OF RESPIRATORS Respirators that fail an inspection or are otherwise not fit for use and cannot be repaired must be discarded. 15

16 TRAINING EH&S will provide effective training based on respiratory hazard assessments and PeopleSoft Hazard Assessment to employees who are required to use respirators. Also, training will be provided to employees who wear respirators when not required. The training will be comprehensive and understandable. Training is required prior to using a respirator in the workplace. Training will be documented using either PeopleSoft or the training form in APPENIDX M. However, if an individual has received training within the previous 12 months, then that employee is not required to repeat such training initially. The training will ensure that each employee can demonstrate knowledge of at least the following: Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective effect of the respirator; What the limitations and capabilities of the respirator are; How to use the respirator effectively in emergency situations, including situations in which the respirator malfunctions; How to inspect, put on and remove, use, and check the seals of the respirator; What the procedures are for maintenance and storage of the respirator; How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators; and The general requirements of the Respiratory Protection Program. Annual training will be done. Retraining will be done when the following situations occur: Changes in the workplace or the type of respirator render previous training obsolete; Inadequacies in the employee's knowledge or use of the respirator indicate that the employee has not retained the requisite understanding or skill; or Any other situation arises in which retraining appears necessary to ensure safe respirator use. RECORD KEEPING MEDICAL RECORDS Employee Health Services will retain the medical questionnaire and any other pertinent medical records in accordance with 29 CFR OTHER RECORDS The WFBMC Program Administrators will retain the following records. Respirator Hazard Assessments Initial and annual PLHCP Forms for respirator use Initial and annual fit testing records for respirator users Initial and annual training forms A written copy of the current respirator program 16

17 PROGRAM EVALUATION AND REVIEW The Respiratory Protection Program shall be reviewed by the Program Administrators annually. WFBMC Program Administrators will evaluate 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. Using APPENDIX M WFBMC Program Administrators will regularly consult employees required to use respirators to assess the employees' views on program effectiveness and to identify any problems. Any problems that are identified during this assessment shall be corrected. Factors to be assessed include, but are not limited to: Respirator fit (including the ability to use the respirator without interfering with workplace performance) Appropriate respirator selection for the hazards to which the employee is exposed Proper respirator use under actual workplace conditions Proper respirator maintenance 17

18 APPENDIX A RESPIRATOR INFORMATION FOR MEDICAL CLEARANCE RESPIRATOR INFORMATION FOR MEDICAL CLEARANCE To be completed by EH&S for either an individual or a common job function. Today's date: Last First Middle Employee s Name: Employee #: Supervisor/Manager: Department Name: Job Title/Code # and Description: SCBA Air-Purifying Respirator and Type Cartridge Date of Birth: Department Number: Weight: 25 lbs. Weight: 1.5 lbs. Filtering facepiece Powered Air-Purifying (PAPR) Expected level of physical work effort (63CFR 1284) (Check and describe all that apply): Light: sitting while writing, typing, drafting, assembly work (<3 mets) Moderate: sitting while nailing or filing, driving a truck or bus in urban traffic, walking on a level (slowly) (<5 mets) Heavy: lifting 50 lbs. from floor to waist or shoulder, loading dock, shoveling, climbing stairs with 50 lbs. (>5 mets) Extent of Usage (Check which one applies): Description: Description: Description: Weight:.05 lbs. Weight: 10 lbs. On a daily basis Occasionally but more than once a week Special Work Considerations (Check and describe all that apply): Protective Clothing Rarely or for emergency situations Maximum Number of Hours of use Per Day (estimate): Description: Vapor Barrier Clothing Description: Special Work Considerations (Check and describe all that apply): Temperature and humidity Description: Personal Protective Equipment Description: Special Work Considerations (Check and describe all that apply): 18

19 Responsibility for health and safety of others, of Public (Security, Rescue, HazMat, Fire Brigade, Nuclear) Dangerous Work Environment (High Voltage, high places, machinery) Hazardous material Hazardous atmosphere (IDLH) Confined Space Communication essential Normal vision essential Description: Description: Description: Description: Description: Description: Description: Description of usual job functions, title, tasks, work activities: 19

20 APPENDIX B1 INITIAL MEDICAL QUESTIONNAIRE Complete form and send to Employee Health Dr. Scott Spillmann. INITIAL MEDICAL QUESTIONNAIRE CONFIDENTIAL MEDICAL INFORMATION SECTION 1. (Employee) Today's date: Last First 1. Name: 2. Your age (to nearest year): 4. Your height: 6. Your job title: 7. Department Name: 9. Address: 10. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the Area Code): 10.a. ft. in. 3. Sex: 5. Your weight: 8. Department Number: Middle Male Female lbs. The best time to phone you at this number? 11. Work Phone Number: 12. Has your employer told you how to contact the health care professional who will review this questionnaire? (Employee Health) 13. Check the type of respirator you will use (you can check more than one ): 1. N, R, or P disposable respirator (filter-mask, non- cartridge type only). 2. Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air, self-contained breathing apparatus). 14. Have you worn a respirator: If yes, what type(s): SECTION Can you read? 2. Do you currently smoke tobacco, or have you smoked tobacco in the last month? 3. Have you ever had any of the following conditions? a. b. c. d. e. Seizures (fits): Diabetes (sugar disease): Allergic reactions that interfere with your breathing: Claustrophobia (fear of closed-in places): Trouble smelling odors: 20

21 4. Have you ever had any of the following pulmonary or lung problems? a. Asbestosis: b. Asthma: c. Chronic bronchitis: d. Emphysema: e. Pneumonia: f. Tuberculosis: g. Silicosis: h. Pneumothorax (collapsed lung): i. Lung cancer: j. Broken ribs: k. Any chest injuries or surgeries: l. Any other lung problem that you've been told about: 5. Do you currently have any of the following symptoms of pulmonary or lung illness? a. Shortness of breath: b. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: c. Shortness of breath when walking with other people at an ordinary pace on level ground: d. Have to stop for breath when walking at your own pace on level ground: e. Shortness of breath when washing or dressing yourself: f. Shortness of breath that interferes with your job: g. Coughing that produces phlegm (thick sputum): h. Coughing that wakes you early in the morning: i. Coughing that occurs mostly when you are lying down: j. Coughing up blood in the last month: k. Wheezing: l. Wheezing that interferes with your job: m. Chest pain when you breathe deeply: n. Any other symptoms that you think may be related to lung problems: 6. Have you ever had any of the following cardiovascular or heart problems? a. Heart attack: b. Stroke: c. Angina: d. Heart failure: e. Swelling in your legs or feet (not caused by walking): f. Heart arrhythmia (heart beating irregularly): g. High blood pressure: h. Any other heart problem that you've been told about: 21

22 7. Have you ever had any of the following cardiovascular or heart symptoms? a. Frequent pain or tightness in your chest: b. Pain or tightness in your chest during physical activity: c. Pain or tightness in your chest that interferes with your job: d. In the past two years, have you noticed your heart skipping or missing a beat: e. Heartburn or indigestion that is not related to eating: f. Any other symptoms that you think may be related to heart or circulation problems: 8. Do you currently take medication for any of the following problems? a. Breathing or lung problems: b. Heart trouble: c. Blood pressure: d. Seizures (fits): 9. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator, check the following space and go to question 9): a. Eye irritation: b. Skin allergies or rashes: c. Anxiety: d. General weakness or fatigue: e. Any other problem that interferes with your use of a respirator: 10. Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire? SECTION Have you ever lost vision in either eye (temporarily or permanently)? 12. Do you currently have any of the following vision problems? a. Wear contact lenses: b. Wear glasses: c. Color blind: d. Any other eye or vision problem: 13. Have you ever had an injury to your ears, including a broken ear drum? 14. Do you currently have any of the following hearing problems? a. Difficulty hearing: b. Wear a hearing aid: c. Any other hearing or ear problem: 15. Have you ever had a back injury? 22

23 16. Do you currently have any of the following symptoms of pulmonary or lung illness? a. Weakness in any of your arms, hands, legs, or feet: b. Back pain: c. Difficulty fully moving your arms and legs: d. Pain or stiffness when you lean forward or backward at the waist: e. Difficulty fully moving your head up or down: f. Difficulty fully moving your head side to side: g. Difficulty bending at your knees: h. Difficulty squatting to the ground: i. Climbing a flight of stairs or a ladder carrying more than 25 lbs: j. Any other muscle or skeletal problem that interferes with using a respirator: Section 4. Any of the following questions, and other questions not listed, may be added to the questionnaire at the discretion of the health care professional who will review the questionnaire. 1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has lower than normal amounts of oxygen? If "yes," do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when you're working under these conditions: 2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with hazardous chemicals? If "yes," name the chemicals if you know them: 3. Have you ever worked with any of the materials, or under any of the conditions, listed below? a. Asbestos: b. Silica (e.g., in sandblasting): c. Tungsten/cobalt (e.g., grinding or welding this material): d. Beryllium: e. Aluminum: f. Coal (for example, mining): g. Iron: h. Tin: i. Dusty environments: j. Any other hazardous exposures: If "yes," describe these exposures: 4. List any second jobs or side businesses you have: 5. List your previous occupations: 6. List your current and previous hobbies: 23

24 7. Have you been in the military services? If "yes," were you exposed to biological or chemical agents (either in training or combat): 8. Have you ever worked on a HAZMAT team? 9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and seizures mentioned earlier in this questionnaire, are you taking any other medications for any reason (including over-the-counter medications): If "yes," name the medications if you know them: 10. Will you be using any of the following items with your respirator(s)? a. HEPA Filters: b. Canisters (for example, gas masks): c. Cartridges: 11. How often are you expected to use the respirator(s) (circle "yes" or "no" for all answers that apply to you)? a. Escape only (no rescue): b. Emergency rescue only: c. Less than 5 hours per week: d. Less than 2 hours per day: e. 2 to 4 hours per day: f. Over 4 hours per day: 12. During the period you are using the respirator(s), is your work effort? a. Light (less than 200 kcal per hour): If "yes," how long does this period last during the average shift: hrs. mins. Examples of a light work effort are sitting while writing, typing, drafting, or performing light assembly work; or standing while operating a drill press (1-3 lbs.) or controlling machines. b. Moderate ( kcal per hour): If "yes," how long does this period last during the average shift: hrs. mins. Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic; standing while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.) at trunk level; walking on a level surface about 2 mph or down a 5-degree grade about 3 mph; or pushing a wheelbarrow with a heavy load (about 100 lbs.) on a level surface. c. Heavy (above 350 kcal per hour): If "yes," how long does this period last during the average shift: hrs. mins. Examples of heavy work are lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder; working on a loading dock; shoveling; standing while bricklaying or chipping castings; walking up an 8-degree grade about 2 mph; climbing stairs with a heavy load (about 50 lbs.). 24

25 13. Will you be wearing protective clothing and/or equipment (other than the respirator) when you're using your respirator? If "yes," describe this protective clothing and/or equipment: 14. Will you be working under hot conditions (temperature exceeding 77 deg. F)? 15. Will you be working under humid conditions? 16. Describe the work you'll be doing while you're using your respirator(s): 17. Describe any special or hazardous conditions you might encounter when you're using your respirator(s) (for example, confined spaces, life-threatening gases): 18. Provide the following information, if you know it, for each toxic substance that you'll be exposed to when you're using your respirator(s): Name of the first toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the second toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: Name of the third toxic substance: Estimated maximum exposure level per shift: Duration of exposure per shift: The name of any other toxic substances that you'll be exposed to while using your respirator: 19. Describe any special responsibilities you'll have while using your respirator(s) that may affect the safety and well-being of others (for example, rescue, security): Signature Date 25

26 APPENDIX B2 ANNUAL MEDICAL QUESTIONNAIRE ANNUAL MEDICAL QUESTIONNAIRE CONFIDENTIAL MEDICAL INFORMATION This information cannot be shared without the written authorization of the employee. Complete form and send to Employee Health Dr. Scott Spillmann. To be Administered and Reviewed Prior to Annual Fit Test. Employee Name: Last Employee #: Today's date: First Middle Date of Birth: Supervisor/Manager: Department Name: Department Number: 1. Have you developed any medical problems or symptoms that may limit your ability to use a respirator? 2. Have you been treated for a heart or lung condition in the past year? (e.g., heart attack, pneumonia) 3. Have you been under treatment by a physician for any other condition in the past year? If yes, please describe the condition. 4. Have you had any surgical operation or medical procedure in the past year? If yes, please describe procedure. 5. Have you been told by a health care professional, your supervisor, or the respirator program administrator or anyone else that you should be medically reevaluated? 6. Have you had a weight gain or loss of more than 10 pounds? 7. Has there been a change in workplace conditions, e.g., physical work effort, protective clothing, temperature, that has resulted in a substantial increase in the physical burden placed on you? 8. Have you had chest pain or pressure? 9. Have you had to remove a respirator because of feeling closed-in (Claustrophobic) or short of breath? 10. What medications are you currently taking? It is your responsibility to report any change in health status that may affect your ability to use a respirator to your Supervisor and/or WFBMC Employee Health Services. Signature Date 26

27 APPENIDIX C PLHCP (WFBMC EMPLOYEE HEALTH SERVICES) FORMS 27

28 APPENDIX C1 PLHCP FORM - PLCHP S RECOMMENDATION TO WFUSM EH&S OR NCBH SAFETY DEPARTMENT. PLHCP FORM PLCHP S RECOMMENDATION TO WFUSM & EH&S OR NCBH SAFETY DEPARTMENT Today's date: Employee Name: Last Employee #: First Middle Date of Birth: Supervisor/Manager: Department Name: Department Number: PLHCP Determination (Check a Class): Class 1: No restriction on respirator use. Class 2: Conditional Use: Some specific use restrictions or medical requirements (e.g., moderate/light work only, PAPR only, no SCBA use, annual medical evaluation, age-specific medical evaluation). Class 3: No respirator use permitted (permanent). Class 4: No respirator use permitted (temporary) you require additional medical evaluation and/or treatment and physician evaluation. Class 5: Additional temporary/permanent (non-respirator) restrictions (e.g., no heavy lifting, no climbing, and no heat stress). Restrictions/Additional Medical Requirements/Findings on Targeted Evaluation: PLHCP Signature: Date: Initial Medical Clearance Follow-up Medical Clearance Annual Medical Clearance 28

29 APPENDIX C2 PLHCP RECOMMENDATION TO EMPLOYEE PLHCP RECOMMENDATION TO EMPLOYEE (CONFIDENTIAL MEDICAL INFORMATION) This Form is Given to the Worker ONLY and Retained by WFBMC Employee Health. This information Cannot be Shared Without the Written Authorization of the Worker. A. Medical evaluation has detected no medical conditions that would prevent you from using a respirator. B. Please note that the following medical conditions (indicated by a check mark) have been identified during your medical evaluation. It is recommended that you discuss the below mentioned health problem(s) with your personal physician. Until these problems are evaluated further, you are temporarily disqualified from performing respirator/heat stress work. Hearing impairment that requires further evaluation. Decreased visual activity: In general 20/40 is desirable for distant vision in one eye with or without correction. Certain jobs have specific vision requirements. Electrocardiogram (EKG): This test was interpreted to be not within the range of normal. The examining physician will provide you with a copy of your EKG so that you can discuss it with your personal physician. Pulmonary Function Test (PFT Breathing Test): This test was interpreted to be significantly below the lower limit of normal. If you smoke, it is strongly recommended that you stop. Blood Pressure Evaluation: o 180/ 110 Your blood pressure is o 140/ 90 Body Mass Index (BMI) >30. This measurement shows that you are overweight. This may have adverse health consequences. History of cardiac disease. Please provide your medical evaluator with a copy of your most recent stress test. It must demonstrate functional capacity in METs with the absence of clinically significant arrhythmia, abnormal blood pressure response, and ischemia. Other: C. PLHCP Determination (Check a Class): Class 1: No restriction on respirator use. Class 2: Conditional Use: Some specific use restrictions or medical requirements (e.g., moderate/light work only, PAPR only, no SCBA use, annual medical evaluation, age-specific medical evaluation). Class 3: No respirator use permitted (permanent). Class 4: No respirator use permitted (temporary) you require additional medical evaluation and/or treatment and physician evaluation (see above). Class 5: Additional temporary/permanent (non-respirator) restrictions (e.g., no heavy lifting, no climbing, and no heat stress). Restrictions/Additional Medical Requirements/Findings on Targeted Evaluation: Date of next medical re-evaluation: PLHCP Signature: Date: 29

30 APPENDIX D RESPIRATORY HAZARD DETERMINATION FORM RESPIRATORY HAZARD ASSESSMENT FORM Today s Date: Assessment Performed by: Area or Department: Process, tasks, job assessed: Number of employees potentially or actually exposed: Shifts involved and hours of operation? Previous concerns/complaints (i.e., signs, symptoms or exposure)? List Review of illness and injury data: Unknown /Oxygen deficient/ IDLH Atmosphere? List information, oxygen levels, etc. Interior structural firefighting or hazmat responses? List duties: List respiratory hazards, air contaminants identified: Air contaminant s chemical state and physical form (i.e. solid, liquid, gas, mists, vapor, fume, particulate): Yes No Estimate of employee exposure: List any workplace and user factors that potentially affects respiratory performance and reliability: Based on the above factors the following respiratory protection is recommended: List the one year anniversary date or when area conditions change that require a re-assessment of the air monitoring data: Below PEL, TVL, STEL, Ceiling At PEL, TVL, STEL, Ceiling Above PEL, TVL, STEL, Ceiling Industrial hygiene monitoring or a calculation based on reasonable estimates of employees exposure should be provided prior to recommending the necessity and use of respirators 30

31 APPENDIX E - RESPIRATOR USAGE & SELECTION RESPIRATOR USAGE & SELECTION Loose fitting hoods will be made available to persons with asthma or other psychological/stress factors. RESPIRATOR TYPE REASON SELECTED LIMITATIONS MANUFACTURER Filtering Facepiece N-95 Where particulate concentrations are at or below PEL Concentrations are at or below. Non-IDLH* and adequate oxygen levels are present. 3M, Moldex, Wilson, Kimberly- Clark Half-mask HEPA Cartridges Protection against particulate Non-IDLH* and adequate oxygen level are present. North/MSA/ 3M Half-mask with Mercury and HEPA Protection against particulate Non-IDLH* and adequate oxygen level are present. North/MSA Full Face APR with HEPA Cartridges Full-face with Organic Vapor and HEPA Cartridge Protection against particulate Protection against particulate Non-IDLH* and adequate oxygen level are present. Non-IDLH* and adequate oxygen level are present. North/MSA North/MSA PAPR Full Face Maximum protection against high particulate levels Non-IDLH* and adequate oxygen level are present. 8 hours 3M Loose Fitting Hood with HEPA Cartridges SCBA Psychological/ Stress; medical clearance IDLH and oxygen deficient atmospheres Non-IDLH* and adequate oxygen level are present. 8 hours IDLH* 3M 3M/Scott/MSA *IDLH - Immediately Dangerous to Life and Health. 31

32 APPENDIX F RESPIRATOR USERS RESPIRATOR USERS Organization DEPARTMENT NAME LOCATION TYPE OF RESPIRATOR WFUSM ARP Hawthorne N-95 WFUSM ARP PTRP N-95 WFUSM ARP Friedberg N-95 WFBMC Hematology/Oncology CCC N-95; N-100 Outpatient Nurses WFBMC Hematology/Oncology Mt. Airy N-95; N-100 Outpatient Nurses WFBMC Hematology/Oncology Elkin N-95; N-100 Outpatient Nurses WFBMC Engineering All N-95, ½ face APR + HEPA/OV Cartridges, full face APR + HEPA/OV cartridges, PAPR + HEPA/OV cartridges WFUSM EH&S All N-95, ½ face APR + HEPA/OV Cartridges, full face APR + HEPA/OV cartridges, PAPR + HEPA/OV cartridges, SCBAs WFBMC Internal Medicine Hawthorne N-95 WFUSM WFUP Pathology Lipid Sciences PTRP ½ face APR + Mercury Cartridges WFBMC Pediatric Oncology Hawthorne N-95 WFUSM - WFUP General Surgery Hawthorne N-95 WFBMC IM Geriatrics Hawthorne N-95 WFUSM - WFUP Plastic Surgery Hawthorne N-95 WFBMC Hazmat Team Hawthorne N-95, PAPR, SCBAs WFBMC Security Hawthorne N-95, PAPR, SCBA WFBMC Emergency Department Hawthorne N-95, PAPR WFBMC Housekeeping Hawthorne N-95, PAPR WFBMC Nursing / Physician Hawthorne N-95 WFUP CLINICS Nursing Staff All N-95 32

33 APPENDIX G USING RESPIRATOR WHEN T REQUIRED (VOLUNTARY USE) Information for Employees Using Respirators When Not Required Under the Standard Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard. You should do the following: 1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirators limitations. 2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you. 3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke. 4. Keep track of your respirator so that you do not mistakenly use someone else's respirator. Employee s Name (Print) Employee s Signature Trainer s Name (Print) Date of training/certification Employees who only use of respirators involves the voluntary use of filtering facepieces (dust masks) will not have to be medically cleared. 33

34 APPENDIX H - FIT TESTING PROTOCOLS 34

35 APPENDIX H1 - QUALITATIVE FIT TEST CHECKLIST QUALITATIVE FIT TEST CHECKLIST Employee Name: General Procedures: 1. Multiple types of models/sizes offered to employee? 2. Demonstration of donning, doffing, positioning, strap adjustment, and proper fit? 3. Employee informed that he/she is being asked to select respirator with best fit? 4. Employee instructed to test each chosen facepiece to eliminate those without acceptable fit? 5. Mask is donned and worn at least five minutes to assess comfort and acceptability? 6. Assessment of comfort: (a) position of the mask on the nose (b) room for eye protection (c) room to talk (d) position of mask on face and cheeks 7. Adequate respirator fit: (a) Chin properly placed; (b) Adequate strap tension, not overly tightened (c) Fit across Nose Bridge (d) Respirator of proper size to span distance from nose to chin (e) Tendency of respirator to slip (f) Self-observation in mirror to evaluate fit and respirator position 8. User seal check negative and/or positive pressure per respirator manufacturer recommendations? 9. Hair growth between the skin and facepiece sealing surface? 10. Apparel and/or PPE interference? 11. Difficulty in breathing (refer back to WFBMC Employee Health) 12. Test Exercises Conduct each exercise for 30 seconds. Normal Breathing Deep Breathing Turning head side to side Moving Head up/down Talking (Rainbow passage, count backwards, etc) 13. Number of squeezes required for sensitivity: Number of squeezes required for fit testing which elicited a positive response: Quantitative Methods: Isoamyl Acetate Saccharine Bitrex Irritant Smoke Sensitivity / Threshold test (odor or taste) OK Passed fit testing Name: Signature: Date: Fit Tester s Name: Signature: Date: 35

36 APPENDIX H2 - QUANTITATIVE FIT TEST CHECKLIST Employee Name: QUANTITATIVE FIT TEST CHECKLIST General Procedures: 1. Multiple types of models/sizes offered to employee? 2. Demonstration of donning, doffing, positioning, strap adjustment, and proper fit? 3. Employee informed that he/she is being asked to select respirator with best fit? 4. Employee instructed to test each chosen facepiece to eliminate those without acceptable fit? 5. Mask is donned and worn at least five minutes to assess comfort? 6. Assessment of comfort: (a) position of the mask on the nose (b) room for eye protection (c) room to talk (d) position of mask on face and cheeks 7. Adequate respirator fit: (a) Chin properly placed; (b) Adequate strap tension, not overly tightened (c) Fit across Nose Bridge (d) Respirator of proper size to span distance from nose to chin (e) Tendency of respirator to slip (f) Self-observation in mirror to evaluate fit and respirator position 8. User seal check negative and positive pressure per respirator manufacturer? 9. Hair growth between the skin and facepiece sealing surface? 10. Apparel and/or PPE interference? 11. Difficulty in breathing (refer back to WFBMC Employee Health) 12. Test Exercises Conduct each exercise for 30 seconds. Normal Breathing Deep Breathing Turning head side to side Moving Head up/down Talking (Rainbow passage, count backwards, etc) Bending over or jogging in place Normal Breathing/Grimace Quantitative Methods: Ambient aerosol condensation nuclei counter (CNC) quantitative fit testing (Portacount) (1) Respirator fitted with a high-efficiency filter (2) Sampling probe and line are properly attached to the facepiece (3) Follow the manufacturer s instruction for operation the Portacount Fit Factor: (Passing for half-face respirator is >100; for tight-fitting full-face negative pressure > 500) Name: Signature: Date: Fit Tester s Name: Signature: Date: 36

37 APPENDIX H3 RAINBOW PASSAGE WHEN THE SUNLIGHT STRIKES RAINDROPS IN THE AIR, THEY ACT LIKE A PRISM AND FORM A RAINBOW. THE RAINBOW IS A DIVISION OF WHITE LIGHT INTO MANY BEAUTIFUL COLORS. THESE TAKE THE SHAPE OF A LONG ROUND ARCH, WITH ITS PATH HIGH ABOVE AND ITS TWO ENDS APPARENTLY BEYOND THE HORIZON. THERE IS, ACCORDING TO LEGEND, A BOILING POT OF GOLD AT ONE END. PEOPLE LOOK, BUT ONE EVER FINDS IT.WHEN A MAN LOOKS FOR SOMETHING BEYOND HIS REACH, HIS FRIENDS SAY HE IS LOOKING FOR THE POT OF GOLD AT THE END OF THE RAINBOW. 37

38 APPENDIX H4 - FIT TEST RECORD FORM Employee Name FIT TESTING RECORD FORM Department Date Employee Signature Type of Fit Test Qualitative (QLFT) Quantitative (QNFT) Type of Respirator FFP ½ mask Full face SCBA PAPR Loose Fitting PAPR Supplier North Kimberly Clark Moldex 3M Other: Size Small Medium Large Fit Factor FFP < 100 half-face respirator >100 tight-fitting full-face negative pressure Fit Test Results Passed Failed Qualified Fit-Test conductor/assessor > 500 Attach the test result from the QNFT. 38

39 APPENDIX I - USER SEAL CHECK PROCEDURES The individual who uses a tight-fitting respirator is to perform a user seal check to ensure that an adequate seal is achieved each time the respirator is put on. Either the positive and negative pressure checks listed in this appendix, or the respirator manufacturer's recommended user seal check method shall be used. User seal checks are not substitutes for qualitative or quantitative fit tests. Facepiece Positive and/or Negative Pressure Checks Positive pressure check. Close off the exhalation valve and exhale gently into the facepiece. The face fit is considered satisfactory if a slight positive pressure can be built up inside the facepiece without any evidence of outward leakage of air at the seal. For most respirators this method of leak testing requires the wearer to first remove the exhalation valve cover before closing off the exhalation valve and then carefully replacing it after the test. Negative pressure check - Close off the inlet opening of the canister or cartridge(s) by covering with the palm of the hand(s) or by replacing the filter seal(s), inhale gently so that the facepiece collapses slightly, and hold the breath for ten seconds. The design of the inlet opening of some cartridges cannot be effectively covered with the palm of the hand. The test can be performed by covering the inlet opening of the cartridge with a thin latex or nitrile glove. If the facepiece remains in its slightly collapsed condition and no inward leakage of air is detected, the tightness of the respirator is considered satisfactory. Manufacturer's Recommended User Seal Check Procedures The respirator manufacturer's recommended procedures for performing a user seal check may be used instead of the positive and/or negative pressure check procedures provided that WFUSM demonstrates that the manufacturer's procedures are equally effective. 39

40 APPENDIX J - RESPIRATOR CLEANING PROCEDURES These procedures are provided for employer use when cleaning respirators. They are general in nature and the employer as an alternative may use the cleaning recommendations provided by the manufacturer of the respirators used by their employees, provided such procedures are as effective as those listed here. Equivalent effectiveness simply means that the procedures used must accomplish the objectives set forth in this procedure, i.e., must ensure that the respirator is properly cleaned and disinfected in a manner that prevents damage to the respirator and does not cause harm to the user. I. Procedures for Cleaning Respirators A. Remove filters, cartridges, or canisters. Disassemble facepieces by removing speaking diaphragms, demand and pressure- demand valve assemblies, hoses, or any components recommended by the manufacturer. Discard or repair any defective parts. B. Wash components in warm (43 0 C [110 0 F] maximum) water with a mild detergent or with a cleaner recommended by the manufacturer. A stiff bristle (not wire) brush may be used to facilitate the removal of dirt. C. Rinse components thoroughly in clean, warm (43 0 C [110 0 F] maximum), preferably running water. Drain. D. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for two minutes in one of the following: Hypochlorite solution (50 ppm of chlorine) made by adding approximately one milliliter of laundry bleach to one liter of water at 43 0 C (110 0 F); or, Aqueous solution of iodine (50 ppm iodine) made by adding approximately 0.8 milliliters of tincture of iodine (6-8 grams ammonium and/or potassium iodide/100 cc of 45% alcohol) to one liter of water at 43 0 C (110 0 F); or, Other commercially available cleansers of equivalent disinfectant quality when used as directed, if their use is recommended or approved by the respirator manufacturer. E. Rinse components thoroughly in clean, warm (43 0 C [110 0 F] maximum), preferably running water. Drain. The importance of thorough rinsing cannot be overemphasized. Detergents or disinfectants that dry on facepieces may result in dermatitis. In addition, some disinfectants may cause deterioration of rubber or corrosion of metal parts if not completely removed. F. Components should be hand-dried with a clean lint-free cloth or air-dried. G. Reassemble facepiece, replacing filters, cartridges, and canisters where necessary. H. Test the respirator to ensure that all components work properly. 40

41 APPENDIX K MONTHLY INSPECTION CARD FOR EMERGENCY RESPIRATORS (SCBAs) MONTHLY INSPECTION CARD FOR EMERGENCY RESPIRATORS (SCBAs) SCBA SERIAL NUMBER INSPECTION DATE INSPECTION PERFORMED BY COMMENTS FACEPIECE Lens clear Clean Protected Pliable Operating Properly HARNESS Frayed or damaged Buckles lock correctly HOSES Good Condition Piable CYLINDER Fully Charged Cylinder Tightly Fastened to Backplate Hydrostatic Test Date: (within 3 years) No Cuts in Fiberglass Wrap Gauge Face Clear ALARMS AND GAUGES Are alarms working? Are gauges working? STORAGE Stored in Clean, dry location 41

42 APPENDIX L TRAINING FORM CERTIFICATE OF TRAINING It is hereby certified that the employee named below can demonstrate knowledge in the following areas: When and why the respirator should be donned and necessary and how improper fit, usage or maintenance can compromise the protective effect of the respirator. What the limitations and capabilities of the respirator are. How to use the respirator effectively during routine and emergency situations, including situations in which the respirator malfunctions. How to inspect, put on (don), remove (doff), use and perform seal checks of the respirator. What the procedures are for maintenance and storage of the respirator. How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators including the specific respiratory hazards and their effects. The general requirements of 29 CFR paragraph (K) that addresses employee training and information. It is further certified that: The training was conducted in a manner that was understood by the employee named below. The training was prior to requiring the employee named below to use a respirator in the workplace. Re-training will be provided if the following occurs in the workplace, or, the new type of respirator renders respirator training obsolete or inadequacies in the employer s knowledge or use of the respirator indicate that the employee has not retained the requisite understanding or skill, or any other situation arises in which retraining appears necessary to ensure safe respirator use. The basic advisory information on respirators, as presented in Appendix C of 29 CFR or APPENDIX F, VOLUNTARY USE of this program has been provided by WFBMC in a written or oral format, to those employees who wear respirators when such use is not required by 29 CFR or by WFBMC. Employee s Name (Print) Employee s Signature Trainer s Name (Print) Date of training/certification 42

43 APPENDIX M RESPIRATOR PROTECTION PROGRAM EVALUATION CHECKLIST AUDITOR: DATE: EMPLOYEE INTERVIEWED: RESPIRATOR PROTECTION PROGRAM EVALUATION CHECKLIST Is there a written program which acknowledges employer responsibility for providing a safe and healthful workplace, and assigns program responsibility, accountability and authority? Is program responsibility vested in one individual who is knowledgeable and who can coordinate all aspects of the program at the job site? Can feasible engineering controls or work practices eliminate the need for respirators? Are there written procedures/statements covering the various aspects of the Respirator Protection Program, including: Designation of an administrator Respirator selection Purchase of NIOSH certified equipment Medical aspects of respirator Usage Issuance of equipment Fitting Training Maintenance, storage and repair Inspection Use under special conditions Work area surveillance PROGRAM OPERATION Respiratory Protection equipment selection Are work area conditions and worker exposures properly surveyed? Are respirators selected on the basis of hazards to which the worker is exposed? Are selection made by individuals knowledgeable of proper selection procedures? N/A COMMENTS 43

44 PROGRAM OPERATION (Continued) N/A COMMENTS Are only certified respirators purchased and used; do they provide adequate protection for the specific hazard and concentration of the contaminant? Has a medical evaluation of the prospective user been made to determine physical and psychological ability to wear the selected respiratory protection equipment? Where practical, have respirators been issued to the users for their exclusive use and are there records covering issuance? RESPIRATORY PROTECTIVE EQUIPMENT FITTING Are the users given the opportunity to try on several respirators to determine whether the respirator they shall subsequently be wearing is the best fitting one? Is the fit test at appropriate intervals? Are those users who require corrective lenses properly fitted? Is the face piece-to-seal tested in a test atmosphere? Are workers prohibited from wearing respirators in contaminated work areas when they have facial hair or other characteristics may cause face seal leakage? RESPIRATORS USE IN THE WORK AREA Are respirators being worn correctly (i.e., head covering over respirators straps)? Are workers keeping respirators on all the time while in the work area? MAINTENANCE OF RESPIRATORY EQUIPMENT CLEANING AND DISINFECTING Are respirators cleaned and disinfected after each use when different people use the same device, or as frequently as necessary for devices issued to individual users? Are proper methods of cleaning and disinfecting utilized? STORAGE Are respirators stored in a manner so as to protect them from dust, sunlight, heat, excessive cold or moisture, damaging chemicals, insects, rodents, snakes, vibrations and shock? 44

45 STORAGE (Continued) N/A COMMENTS Are respirators stored properly in a storage facility so as to prevent them from deforming? Is storage in lockers and toolboxes permitted only if the respirator is in a carrying case or carton? INSPECTION Are respirators inspected before and after each use and during cleaning? Are qualified individuals/users instructed in inspection techniques? Is respiratory protective equipment designated as emergency use inspected at least monthly (in addition to after each use)? Are SCBA incorporating breathing gas containers inspected weekly for breathing gas pressure? Is a record kept of the inspection of emergency use respiratory protective equipment? REPAIR Are replacement parts used in those of the manufacturer of the respirator? Are repairs made by manufacturers or manufacturer-trained individuals? SPECIAL USE CONDITIONS Is a procedure developed for respiratory protective equipment usage in atmospheres immediately dangerous to life or health? Is a procedure developed for equipment usage for entry into confined spaces? TRAINING Are users trained in proper respirator use, cleaning and inspection? Are users trained in the basis for selection of respirators? Are users evaluated, using competency-based evaluation, before and after training? 45

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