THE COHEN GROUP
  Environmental Health & Safety Consulting Services

The Cohen Group Newsletter - Volume 7  Issue 1, Article 3.  January, 2005

Emergency Respirator Amendment For Healthcare Workers
By Tim Bormann, CIH

 The Cal/OSH Standards Board approved an emergency amendment to the respiratory protection standard (8 CCR §5144) with a temporary exception for health care workers who wear N95 or other filtering facepiece respirators for control against tuberculosis exposure. Federal OSHA decided not to pursue a respiratory protection standard for tuberculosis. As a result, effective October 18, the Cal/OSHA Standards Board repealed a "place holder" respirator standard for tuberculosis (8 CCR 5147). The repeal of Section 5147 required healthcare employers to immediately comply with Section 5144 to ensure that employees who use respiratory protection be provided with medical evaluations, fit-testing and training.

Health care providers objected to the initial Standards Board requirement stating that immediate fit-testing and medical evaluations posed a financial and logistic hardship. In a recent respirator fit-testing compliance survey conducted by the American Association of Occupational Health Nurses, sixty-nine percent of the respondents reported a high level of difficulty in complying with the OSHA requirement. Seventy-two percent of the survey respondents work at non-government not-for-profit hospitals. In addition, a majority of the hospitals reported a small employee health staff of fewer than three people responsible for fit-testing between 500 and 5,000 employees.

To ease the financial and logistical burden on healthcare facilities, the Cal/OSHA Standards Board approved a phase-in of the respirator requirements until January 18, 2005. First, employers using filtering facepieces for TB protection can rely on medical evaluations obtained prior to October 18, 2004 to meet the initial medical evaluation requirement as long as the evaluation consisted of an acceptably administered questionnaire, medical exam, or both, and the employer received a written determination that the employee is medically able to wear a respirator.

Second, the employer may delay compliance with the annual fit testing requirements until January 18, 2005 for employees in "low risk" settings. However, "high risk" employees must be fit-tested by October 18, 2004. "High risk" groups are designated by the employer as those employees who work in respiratory therapy and other high risk settings. The extension of the compliance deadline does not apply to employers who do not classify employees potentially exposed to tuberculosis by risk.

Though some healthcare providers may find fit-testing a burdensome requirement, a properly fitted respirator is critical in providing protection from inhalation hazards such as tuberculosis. In order for the respirator to be effective, it must be properly selected and fitted to the user. Annual fit-testing and training have been shown to be effective in minimizing respirator seal leakage and in reducing the frequency tuberculosis conversions to health care workers.

The Cohen Group provides environmental health and services to numerous health care facilities including conducting bioaerosol assessments for infection control and assessing employee health and safety issues.