Respiratory Protection University of California Irvine Medical Center Environmental Health and Safety Procedures Section: Safety Reviewed/Revised: 05/10 1. Introduction Good health depends on breathing clean air. In some labs, medical facilities, and maintenance environments the air may at times become contaminated with materials that are hazardous to breathe. The UCI Healthcare Respiratory Protection Program establishes guidelines for the use of respirators to protect the health of employees who, are (or could be) exposed to hazardous substances or atmospheres during their normal duties. This includes Facilities Painters and the Emergency Room Staff who may need to decontaminate patients after an incident. 2. Hazards to the Respiratory System The body s respiratory system is constantly working to clean and purify the air that is inhaled. Some occupational activities and/or environments require the extra protection of equipment that will protect against hazards that may enter the body through the nose and mouth when a person breathes. Like clean air, many of these hazards are invisible and odorless. Breathing (or respiratory) hazards include dusts, fumes, mists; gases and vapors; oxygen deficient atmospheres and temperature extremes. Knowing the characteristics of each hazard helps to understand why respiratory protection is so important. Dusts, Fumes, and Mists - are tiny particles that float in the air. Dusts are formed when solid materials are broken down in activities such as sanding, grinding, or crushing. Fumes occur when metal is melted, vaporized, then quickly cooled, creating very fine particles that drift in the air - welding and furnace work are likely to produce fumes. Mists are tiny liquid droplets usually created by spraying, mixing, or cleaning activities. Mists may be a combination of several hazardous ingredients. When hazardous dusts, fumes, or mists are breathed in, they become trapped in the respiratory system causing irritation. Short-or long-term health problems or even death may result. Gases and Vapors - are invisible contaminants mixed in the air. Gases are substances that become airborne at room temperature. Gases are often produced by chemical processes and high-heat operations. They drift quickly and undetected from their source. Vapors are formed when liquids or solids evaporate, typically occurring with solvents, paints, or refining activities. Breathing hazardous gases or vapors irritates the respiratory system, causing either short- or long-term health problems or even death. Oxygen Deficiency - a lack of oxygen in the air. Oxygen deficiency can be caused by chemical reactions, fire, or displacement by other gases. In confined spaces, where ventilation is very limited or non-existent, aerobic bacterial growth and oxidation of rusting metals can also cause an oxygen deficient atmosphere. Oxygen comprises only about 21% of the air we breathe. However, when levels of oxygen fall below 19.5% (minimal acceptable level), the situation becomes life threatening. Oxygen deficiency is a very serious situation that can cause loss of consciousness or death in minutes. Respiratory Protection Page 1 of 10 1
3. Work Area Surveillance The Program Administrator should be contacted for an area evaluation of the exposure to respiratory hazards. The Program Administrator may consult with an Industrial Hygienist (IH) for air monitoring. The IH and the Program Administrator will consult with the Supervisor to determine the proper type of protection needed. 4. Approvals All respiratory protective equipment used at UCI Healthcare must be approved by NIOSH. The equipment must be used according to any restrictions or limitations stated in the NIOSH approval. The following types and brands of respirators and cartridges are approved by UCI Healthcare: 3M Breathe Easy Turbo PAPR Assembly (p/n 70-0710-4028-4) 3M FR-57 (p/n 70-0708-8966-5) Others may be approved by the Program Administrator on a case-by-case basis. IN NO CASE MAY ANY TYPE OF RESPIRATORY PROTECTIVE EQUIPMENT OR ACCESSORIES BE PURCHASED FROM A VENDOR WITHOUT PRIOR APPROVAL FROM THE PROGRAM ADMINISTRATOR. 5. Respirator Selection Selection of the appropriate respirator for the job is important. Factors that need to be considered are: the work being performed, the nature of the materials or chemicals being worked with, the potential hazardous contaminant or condition, the concentration of the contaminant, limitations of the wearer and equipment, and other control measures being used. Only NIOSH certified respirators will be selected and used. CAUTION: IF THERE IS ANY DOUBT AS TO THE CONCENTRATION OF CONTAMINANT, DO NOT ENTER THE AREA. 6. Voluntary Use for Nuisance Dust Employees who voluntarily use dust mask respirators will not be required to have a medical review or respirator training at EH&S. However, all voluntary dust mask users must follow the procedure outlined in this program The following conditions must exist in order for dust mask respirators to be used voluntarily: Exposure to airborne contaminants is below OSHA permissible exposure limits (PELs) Exposure is only to non-toxic nuisance materials (plant dust, agar dust, etc.) There is no exposure to airborne infectious disease agents The dust mask is not worn to reduce exposure to gases or vapors Respiratory Protection Page 2 of 10 2
7. Medical Evaluations Employees will not be assigned to tasks requiring use of respirators unless it has been determined that they are medically and physically able to perform the work and they can demonstrate knowledge of the proper use of the equipment. Baseline Medical Before receiving an air purifying respirators, all employees potentially exposed to hazardous materials must complete a Respirator Medical Evaluation Questionnaire, and may be required to have a baseline medical exam. The baseline exam is the first and will serve as a reference for all subsequent exams. Annual Medical All UCI Healthcare employees who have been trained to wear air purifying respirators will complete the Respirator Medical Evaluation Questionnaire, on an annual basis and may be required to have a medical exam based on the questionnaire review. The department supervisors are responsible to keep track of the employee s last date of the Respirator Medical Evaluation Questionnaire for their respective employees. 8. Requirements for Fitting and Testing Only a respirator that fits properly can provide proper protection. Face shape, facial hair, eyeglasses, missing dentures, and certain skin conditions can all affect how a respirator fits. Choosing a respirator that both fits properly and provides the proper protection is essential. Before an employee is allowed to use respirator with a negative or positive pressure tight-fitting face piece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used, and at least annually thereafter. The employees using a tight-fitting facepiece respirator shall pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT). The employees shall be additionally fit tested whenever the employee reports, or visual observations are made 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. The face-piece seals must seat well against the face to ensure a leak-proof fit. Anything interfering with this seal dramatically lowers the amount of protection provided. Inhaled contaminated air will always travel through any gap in the face-piece seal. Respiratory protection will not be worn in areas of potential exposure unless the respirator properly fits the employee s face. Situations such as facial hair (sideburns, beards, and heavy mustaches) that prevent a good face to respirator seal will not permit a good seal. If you CANNOT achieve a proper fit, DO NOT enter the contaminated area. See your supervisor. 9. Operating Procedures and Limitations for Respiratory Equipment It is important to use proper procedures when wearing respiratory equipment. Improper usage could result in employee exposure, injury or, in extreme circumstances, death. Respiratory protection equipment is specialized for certain environments, contaminants and conditions of use, so it is important to remember that respirators do have limitations. Respiratory Protection Page 3 of 10 3
General Use Procedures Employees will use their respirators under conditions specified by this program, and in accordance with the training they receive on the use of each particular model. In addition, the respirator shall not be used in a manner for which it is not certified by NIOSH or its manufacturer. All employees shall conduct user seal checks each time that they wear their respirator. Employees shall use either the positive or negative pressure check (depending on which test works best for them). Emergency Procedures All employees shall leave a potentially contaminated work area when the following conditions occur; If increased breathing resistance of the respirator is noted. If severe discomfort in wearing the respirator is detected. Upon illness of the respirator wearer, including: sensation of dizziness, nausea, weakness, breathing difficulty, coughing, sneezing, vomiting, fever and chills. To wash face to prevent skin irritation. Respirator Malfunction For any malfunction of a respirator (e.g., such a breakthrough, facepiece leakage, or improperly working valve), the respirator wearer should inform his or her supervisor that the respirator no longer functions as intended, and go to a safe area to maintain the respirator. The supervisor must ensure that the employee receives the needed parts to repair the respirator, or is provided with a new respirator. Additionally, employees will be required to immediately leave the contaminated or infected area: Upon malfunction of the respirator such as a reduction in air flow of a PAPR. Upon detection of leakage of contaminant into the respirator. Breathing through the respirator becomes more difficult. 10. Training Workers will be trained prior to the use of a respirator, and whenever supplemental training is deemed necessary, or when conditions in the workplace effecting respirator use change. All employees who are required to use a respirator must be properly trained before a respirator is issued to them. The training will include; 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; Respiratory Protection Page 4 of 10 4
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; Employees who need to use more specialized equipment, such as self-contained breathing apparatus, must receive special training. Such training can be provided by the equipment manufacturer or by other qualified individuals approved by the Program Administrator. 11. Cleaning, Disposal, Inspection, Maintenance and Storage Respiratory protection equipment should be inspected prior to use. This ensures that the respirator is clean, in good condition and ready to wear. Follow manufacture s recommendations for cleaning, maintenance, inspection, storage, and disposal. Cleaning Respirators are cleaned and disinfected: As often as necessary when issued for the exclusive use of one employee; Before being worn by different individuals; After each use for emergency use respirators; and After each use for respirators used for fit testing and training. Disposable Respirators Discard after use. Discard if soiled. If breathing becomes difficult, or if structural integrity is compromised. Inspecting Respirators used in routine situations shall be inspected before each use and during cleaning. Should any defects be noted, the respirators will be taken to the supervisor. Damaged respirators will be either repaired or replaced. Maintenance Respirators are to be properly maintained at all times in order to ensure that they function properly and protect employees adequately. Maintenance involves a thorough visual inspection for cleanliness and defects. Worn or deteriorated parts will be replaced prior to use. No components will be replaced or repairs made beyond those recommended by the manufacturer. Repairs to regulators or alarms of atmosphere-supplying respirators will be conducted by the manufacturer. Storage Respirators need to be accessible to the work area. Storage of respirators must be done properly to ensure that the equipment is protected and not subject to environmental conditions that may cause deterioration. Ensure that respirators are stored to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture,, and damaging chemicals. In addition, follow applicable manufacturer s instructions. Respiratory Protection Page 5 of 10 5
12. Documentation and Recordkeeping A copy of this program is available on the UCI Healthcare Safety SharePoint to all employees who wish to review it. 13. Program Evaluation This program will be periodically reviewed to reflect necessary changes and evaluated to ensure its effectiveness. This evaluation will be a collaborative effort and will include (but not be limited to) representatives from the following departments Environmental Health & Safety, Occupational Health, Infection Prevention. This evaluation will be shared with the Organization through the respective committees. 14. References California Code of Regulations, Title 8, 5144 Respiratory Protection Reviewed By: Environment of Care Committee Safety Committee EIP Committee Respiratory Protection Page 6 of 10 6
Appendix A Types of Respiratory Protection Disposable Nuisance Dust Masks Disposable dust masks are air-purifying masks that cover the nose, mouth, and chin. The face piece is a filter that captures particles, purifying the air as the user breathes. Disposable dust masks are only to be used when the contaminants are nuisance dusts. Limitations Disposable dust masks offer very little protection due to poor sealing characteristics. Since they provide no protection against gases and vapors and supply no oxygen, they cannot be used in oxygen deficient areas or for protection against toxic contaminants. They cannot be worn when facial hair extends under the face piece sealing area. Procedure To put on and adjust a disposable dust mask: Inspect your mask: Check for any signs of wear or deterioration. Hold the mask so the narrow nose-cup points upward. Grasp both of the mask straps and pull them over the head while keeping the mask on the face. Place the bottom strap behind the neck; place the top strap on the top of and behind the head. Pinch the metal nose piece to obtain a better fit. Respiratory Protection Page 7 of 10 7
Disposable Nuisance Dust Respirators These combine the face-piece and filtering medium into one unit. They are intended only for nuisance dusts and mists, and are not fit-tested. They cannot be used for exposure to dusts or mists with a Threshold Limit Value (TLV) of more than 0.05 mg/m3. Limitations These masks do not supply oxygen. Do not use in atmospheres containing less than 19.5% oxygen. Do not use when concentrations of contaminants are immediately dangerous to life and health, are unknown or when concentrations exceed 10 times the permissible exposure limit (PEL) or according to specific OSHA standards or applicable government regulations, whichever is lower. Do not alter, abuse or misuse this mask. Do not use with beards or other facial hair or other conditions that prevent a good seal between the face and the sealing surface of the mask. Respirators may help protect your lungs against certain airborne contaminants, however, they will not prevent entry through other routes such as the skin, which would require additional personal protective equipment (PPE). Individuals with a compromised respiratory system, such as asthma or emphysema, should consult a physician and complete a medical evaluation prior to use. If mask becomes damaged, soiled, or breathing becomes difficult, leave the contaminated area immediately and replace the mask. Procedure Read and follow all instructions provided by the respirator manufacturer on use, maintenance, cleaning, care, and warnings. Place the bottom elastic strap around the head, just below the ears. Pull the top strap over your head, resting it above the ears at the top back of your head. Adjust the strap tension. Place your fingertips from both hands at the top of the metal nosepiece. Mold the nose area to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece. Pinching the nosepiece using one hand may result in improper fit and less effective respirator performance. Use two hands. Perform a User Seal Check prior to each wearing. To check the respirator-to-face seal, place both hands completely over the respirator and inhale sharply. Be careful not to disturb the position of the respirator. A negative pressure should be felt inside the respirator. If any leakage is detected, readjust the position of the respirator according to steps above. Respiratory Protection Page 8 of 10 8
Respiratory Protection Against M. tuberculosis Availability and Types for Use All employees potentially exposed to M. tuberculosis will use Technol N95 disposable, negative-pressure particulate respirators under the guidelines in the Tuberculosis Control Plan. For more information on the use of Technol N95 disposable negative pressure particulate respirators, please see the ATD Exposure Control Plan as included in the University of California Irvine Health Systems Policy and Procedure Manual. Procedure Pre-shape the nose clip at the top center of the respirator as it will rest over the bridge of the nose. Hold the respirator in one hand with straps dangling beneath and the inside of the respirator facing upward. Hold the respirator against the face, pull the top head strap over the head and position it above the ears. Pull the lower head strap over the head and position it around the neck below the ears. Hold the nose clip while pulling down on the bottom of the respirator to open the pleats and position the bottom of the respirator just beneath the chin. Press nose clip to form along the nose on both sides until a good seal is established. FIT CHECK: Place both hands on the edges of the respirator, being careful not to disturb the position of the respirator. Exhale sharply to detect any leakage. If you detect air leaks, re-position or re-don the mask as needed to achieve a satisfactory seal. Donning and Fitting Removal of Respirator After use, microorganisms may be present on the exterior surface of any mask or respirator. Remove the used protective device carefully, avoiding self-contamination, and immediately sanitize hands. Disinfect surfaces in the immediate area where droplets of microorganisms may have fallen. Important If you cannot achieve a satisfactory fit, do not enter the contaminated area. Failure to follow all instructions and limitations can seriously reduce the effectiveness of any respirator and could lead to illness, injury or disease. Respirators cannot completely eliminate the risk of contracting disease or infection. i Respiratory Protection Page 9 of 10 9
Powered Air Purifying Respirators (PAPR) Availability and Types For Use - Powered Air Purifying Respirators (PAPR) are belt-mounted, battery-operated blower respirators. Contaminated air is pulled through a cartridge or filter that purifies the air. Once the air is purified, it is fed in a continuous stream to the face piece. Since the blower has rechargeable batteries, it can be reused with the addition of a freshly charged battery or after the batteries have been recharged. Limitations A PAPR with a belt-mounted blower and selected cartridges cannot be used in oxygen-deficient atmospheres, IDLH atmospheres or chemical emergency response situations. The batteries should be fully charged before using the blower. Procedure Inspect your equipment. Check for any signs of wear or deterioration. Make sure the appropriate cartridge(s)/filter(s) are securely attached. Mount the unit on your waist and adjust the belt until it is comfortable. Put on the face mask. Turn the blower on. Air will flow into the mask. Respiratory Protection Page 10 of 10 10