UNIVERSITY OF CONNECTICUT HEALTH

UNIVERSITY OF CONNECTICUT HEALTH CENTER

Written Respirator Program

for the

Selection and Use of Respirators

PRIVATE

(4/06)

I. INTRODUCTION:

The procedures outlined in this plan must be followed for every Health Center activity when respirators must be used to protect employee health. Health Center Policy requires compliance with CT OSHA standards and regulations. These procedures implement requirements set by OSHA regulations. Appendix A covers the use of NIOSH approved respirators for protection against tuberculosis (TB ,TB Respiratory Isolation). Appendix B covers the use of NIOSH approved respirators for protection against air contaminated with harmful concentrations of dusts, mists, fumes, gases and/or vapors (e.g., industrial, fire fighting, and laboratory type activities) in accordance with 29 CFR 1910.134. Appendix C covers the requirements for individuals designated as “First Receivers”. This policy is available on the Office of Research Safety website. Appendix D describes the requirements of 29 CFR 1910.134 Appendix D regarding the voluntary use of respirators.

II. SCOPE:

These procedures apply to the use of respirators by Health Center employees to protect their health. As far as feasible, employee exposure control will be accomplished by following good work practices (e.g., substituting less toxic materials, keeping the quantities of chemicals used small, etc.) and engineering controls (e.g., local exhaust ventilation such as a laboratory hood) so that respirators are not needed. When such controls are not feasible, and as an interim measure while controls are being instituted, respirator use may be required. The use of respirators will be in accordance with applicable OSHA requirements and these procedures. Employees participating in the respiratory protection program do so at no cost to them. The costs associated with this respiratory protection program will be borne by the Health Center for Health Center Employees.

These procedures do NOT apply to the medical use of surgical masks such as those to protect the mouth and nose from a droplet/spray of human blood and other potentially infectious materials in accordance with the UCHC Exposure Control Plan for Bloodborne Pathogens or protect patients/animals from contamination from the provider or researcher. The use of surgical masks for protection of the worker against harmful levels of chemicals or for TB Respiratory Isolation is not permitted by the Health Center or OSHA regulations.

In addition, some employees may express a desire to wear respirators during certain operations where respiratory protection is not required. As a general policy, the Office of Research Safety will review such requests on a case-by-case basis. If the use of respiratory protection in such a case will not jeopardize the health or safety of UCHC employees, a NIOSH approved respirator(s) may be provided to the employee for voluntary use. Such voluntary respirator use is subject to certain requirements of this program. This includes medical evaluation, instructions pertaining to cleaning, maintenance, storage and the need to provide the employee with certain case specified information. Employees who voluntarily wear filtering nuisance [dust masks] devices are not subject to the medical evaluation, cleaning, storage, and maintenance provisions of this program.

III. RESPONSIBILITIES:

The Director, Office of Research Safety (x2723) is responsible for administering the respiratory protection program. Duties of the Director as Respirator Program Administrator include:

· Identifying work areas, processes or tasks that require workers to wear respirators and making appropriate hazard evaluations.

· Selecting respiratory protection options.

· Monitoring respirator use to ensure that respirators are used in accordance with this program and the criteria used in selecting the respirator.

· Arranging for and/or conducting training.

· Ensuring proper storage and maintenance of respiratory protection equipment.

· Conducting appropriate qualitative fit testing.

· Maintaining non-medical records required by the program.

· Evaluating the program.

· Updating this written program, as needed.

The UCHC Deputy Fire Chief is responsible for the above Program Administration responsibilities as they apply to UCHC Fire Department Employees, except for TB Respirators. For TB respirators, the UCHC firefighters will be covered by Appendix A and they will be trained as needed and fit tested the same as other UCHC employees. The UCHC Fire Department will obtain and maintain certificates documenting that the air used for their supplied air respirators conforms to breathing air quality standards.

The Medical Director, Employee Health Service (EHS) (x2893) is responsible for ensuring all respirator medical evaluations and examinations are done as required. This includes documentation of medical actions, medical notification to employees in accordance with 29 CFR 1910.134 for industrial/general industry respirators. When other physicians are associated with the medical evaluation process, Employee Health Service will coordinate all actions. Employee Health Service will also respond promptly to any concerns raised by employees on the respiratory protection program, as applicable. They will maintain required medical records and recall employees at the prescribed frequencies. Such medical evaluations will be provided during the employee’s normal work hours or at a time and place convenient to the employee.

Supervisors are responsible for ensuring that the respiratory protection program is implemented in their particular areas. In addition to being knowledgeable about the program requirements for their own protection, supervisors must also ensure that the program is understood and followed by their employees. Duties of the supervisor include:

· Ensuring that employees under their supervision (including new hires) have received appropriate training, fit testing, and annual medical evaluations as required to comply with the OSHA Respirator Standard.

· Ensuring the availability of appropriate quantity, size and model respirators and accessories.

· Being aware of tasks requiring the use of respiratory protection.

· Enforcing the proper use of respiratory protection (e.g., not allowing respirator use when facial hair would interfere with a tight fitting negative pressure respirator).

· Ensuring that respirators are properly cleaned, maintained, and stored according to the respiratory protection plan.

· Ensuring that respirators fit well and do not cause discomfort.

· Continually monitoring work areas and operations to identify potential respiratory hazards that need to be evaluated in accordance with this program.

· Coordinating with the Office of Research Safety on how to address new or changed respiratory hazards or other concerns regarding the program.

Facilities Management, Environmental Control Center has the responsibility for maintaining Powered Air Purifying Respirators (PAPRs) and making them readily available should the need arise. These respirators are also used by Facilities Staff to enter areas that are not IDLH or for emergency response. Typical use would be to deliver a portable HEPA filter unit to a TB isolation room. Facilities management must ensure that all possible users are trained annually by the Office of Research Safety.

The employee has the responsibility to wear his or her respirator when and where required and in the manner in which they were trained. Employees must also:

· Use their respirator for only the tasks it was selected for.

· Care for and maintain their respirators as instructed, and store them in a clean sanitary location.

· Don and wear their respirator as they were trained.

· Inform their supervisor if the respirator no longer fits well and request initiation of new fit testing so that a new respirator model/size that fits properly can be selected and issued.

· Inform their supervisor, the Office of Research Safety (x2723) or Employee Health Service of any respiratory hazards that they feel are not adequately addressed in the workplace and of any other concerns that they have regarding the program.

· For Industrial/General Industry Respirators, change canisters or cartridges of air purifying respirators as instructed/trained during the fit testing/training session.

· Not enter an area designated as requiring respiratory protection without donning NIOSH approved respirators with concomitant medical clearance, fit testing and training.

· If necessary, comply with annual fit testing, training and medical evaluation requirements.

IV. RESPIRATOR SELECTION:

When a worker must wear a respirator for protection against a possible airborne hazard the type will be specified by the Office of Research Safety, Environmental Health and Safety Office (EHSO) after evaluating the conditions of use and the hazard(s) to which the worker may be exposed. These procedures also apply to the use of respirators for radiation protection. In such cases both the EHSO and he Radiation Safety Office (x2250) will make the selection. Only respirators approved by NIOSH (National Institute of Occupational Health and Safety) shall be used. The type of respirator selected must fit the individual and be suitable for the hazard (e.g., chemical, the anticipated chemical concentrations and/or airborne hazard, presence of oil mist, TB, etc). Other factors that will be considered will be: comfort, user acceptance, toxicity, warning properties and physical state of the chemical (gas/vapor, particulate, etc.).

For UCHC Firefighters, when circumstances result in potential exposure to unknown toxic chemicals or potentially hazardous chemicals concentrations that are unknown, the environment will be considered immediately dangerous to life and health (IDLH) and only self-contained breathing apparatus (SCBA) operated in a positive pressure mode will be used. The senior UCHC Firefighter will also make sure that for UCHC employees other CT OSHA regulations are complied with and these include (but are not limited to) HAZWOPER (29 CFR 1910.120), Confined Space (.146), Bloodborne Pathogens (.1030), etc. After evaluation and if specifically agreed to by both the Office of Research Safety and the senior UCHC Firefighter, other types of respirators may on a case by case basis be used provided all other parts of the UCHC respirator program (training, medical evaluations, qualitative fit testing) have been satisfied.

Selection procedures used by the Office of Research Safety, Environmental Health and Safety Office, will include as appropriate:

1. Identification and evaluation of the hazardous substances used in the workplace or work process for which respiratory protection is being considered.

2. Consideration of other exposure factors (skin absorption, eyes, etc.) and other exposure control recommendations (including use of engineering controls, process changes, need for other types of personal protective equipment (PPE) in accordance with the UCHC PPE Policy, etc.).

3. Exposure monitoring or assessment, as applicable, to quantify potential hazardous exposures based on established occupational exposure standards and materials. Respirator will not be issued when monitoring data suggest elevated levels above the IDLH of the compound and/or an oxygen deficient environment ( <19.5% oxygen).

4. Consideration of information on end of service life indicators and/or information on cartridge/canister service life.

V. RESPIRATOR FITTING AND TRAINING:

Once the type of respirator has been specified by the Office of Research Safety, the employee will select and be fitted with a style and size that is as comfortable as possible (a snug fit is necessary for negative pressure air purifying respirators). The employee will be able to select an air purifying respirator from at least two models or sizes.

For industrial/general industry respirators, the medical evaluation will be completed prior to the fit test. After medical approval to wear the industrial/general industry respirator has been given by Employee Health Service, the qualitative fit test will be performed by an Office of Research Safety representative (or an individual approved by the ORS) using a protocol referenced in 29 CFR 1910.134.

Respirators for TB protection will also require medical evaluation prior to fit testing, will be fit tested by the Office of Research Safety representative, or an individual approved by the ORS in accordance with 29 CFR 1910.139 as outlined in Appendix A. These respirators will be NIOSH approved HEPA or N95 respirators.

Voluntarily Issued Respirators will be provided when requested by the employee or recommended for use by the Employee Health Service, the Office of Research Safety or an individual supervising an employee. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. This category of respirator will be issued in instances where there is potential exposure to animal dander/hair, dusts or used when adequate engineering controls are in place to control a hazard and worker exposure is less than the PEL. This category of respirator shall not be used in the workplace where protection from an air contaminate is needed to keep exposures less than the appropriate PEL. Medical clearance, fit testing and training on the use of such respirators will be done initially and yearly follow up encouraged.

As part of the selection and fit testing, the employee will be provided necessary training on correct donning, adjustments, applicable pressure tests to be made by the user prior to every use, limitations of the respirator, maintenance and storage requirements, etc. For cartridge/canister respirators, instructions will also be given on change frequency and this will be included on the fit test form. EHSO will periodically (reference as appropriate 29 CFR 1910.134 or .139) and at the request of a Department Head, P.I. or employee conduct annual refresher classes on respirator use.

Respirators for FIRST RECEIVERS and Other PAPR Use are maintained in the Emergency Department, the Environmental Control Center, both of which operate 24/7. PAPR’s are also available in a very limited number in the Office of Research Safety.

If the respirator to be used does not require a tight fit (PAPRs), fit testing is not required (fit testing is required for tight fitting supplied air respirators even when only operated in a positive pressure mode). However, individuals using PAPRs are required to have proper training prior to use. Individuals in the Emergency Department and the Environmental Control Center who may be called upon to don a PAPR are trained yearly. Others (ie: those who failed a conventional respirator fit test) are trained during fit testing or are trained as needed. See Appendix C for FIRST RECEIVER requirements.

VI. MEDICAL EVALUATIONS:

ALL Respirators will be used ONLY by employees who are physically able to do so as determined by the Medical Director, Health Center's Employee Health Service (EHS). The Medical Director may designate qualified individuals for such determinations.

When it has been determined that an employee must be required to wear an industrial/general industry respirator for protection against chemical overexposure or for protection from TB exposure, the supervisor will contact the Office of Research Safety (x2723). The ORS will evaluate the potential hazard(s) and controls. The ORS will then specify the basic type of respirator to be utilized. The ORS may restrict such respirator use to an interim period while changes in procedures or engineering controls are being instituted. The supervisor will then schedule the employee to (report to) Employee Health Service with the respirator user form that has been partially completed by the ORS. That partially completed form will provide Employee Health Service with the information required by 29 CFR 1910.134 (see Appendix B). Employee Health Service will medically evaluate and determine the physical ability of the employee to use any respirator and/or the type respirator selected. Employee Health Service will then notify in writing the employee, the supervisor and the ORS of their conclusion. The supervisor will then schedule the individual for fit testing with the ORS. Until an approved medical qualification is received from EHS and the fit testing has been completed by ORS, the employee(s) will not perform tasks requiring the use of a respirator to prevent exposure. Alternative procedures may be implemented to provide for more efficient processes to complete training, medical evaluation and fit testing. The Office of Research Safety will not fit test any individual without a prior medical clearance.

Employee Health Service (EHS) will reevaluate at least annually employees who have a continued need to perform tasks where a respirator is required. If upon reevaluation or because of an EHS consultation visit, the employee is determined by EHS not to be physically able to use a respirator, the employee, EHSO and supervisor will be notified in writing by EHS. Alternative measures may be taken to ensure sufficient protection in lieu of a negative pressure respirator such as using a PAPR or changing work duties. The frequency and content of the medical qualification procedures will be based on the medical judgment of Medical Director, EHS. For tight fitting Industrial/General Industry Respirators, the medical evaluations will be in accordance with 29 CFR 1910.134 and done at least yearly, except as exempted for voluntary use (Appendix D) or as specified for TB respirators (Appendix A).

VII. EMERGENCY SITUATIONS:

For chemical exposure control in emergencies when concentrations are unknown and/or may be immediately dangerous to life and health, such as in a significant chemical spill, only trained fire department personnel with self contained breathing apparatus operated in a positive pressure mode shall enter the area. An appropriate restricted area shall be established by the Fire Department Incident Commander and others will be restricted from entry into the restricted area. Personnel discovering such an emergency will alert others to leave the room, close the door, and dial "7777" for emergency response by the UCHC Fire Department. As the situation is evaluated by the Fire Department Incident Commander in coordination, as appropriate, with the user of the area and the Office of Research Safety, additional occupational exposure evaluations will be made to determine additional actions or assistance needed.

VIII. OTHER GENERAL REQUIREMENTS:

1. Face Seal: Respirators relying on negative pressure for protection shall NOT be worn in atmospheres which would result in a chemical or TB exposure when conditions prevent a good facepiece to face seal. Such conditions might be a growth of beard, sideburns, skull cap, temple pieces of glasses that break the seal of a tight fitting facepiece, etc.

2. Corrective Lenses: If corrective lenses or goggles are required, they will be worn so as not to affect the fit of the facepiece. Contact lenses may be worn with respirators; as appropriate for the anticipated exposure, suitable eye protection will be worn.

3. Eye/Face Protection: With half-mask respirators, eye protection may also be required. Thus, for fitting of respirators used for chemical protection the worker should bring to the Office of Research Safety any corrective glasses and/or chemical safety goggles that would need to be worn.

4. Skin Absorption: Skin absorption for some chemicals may also be a significant exposure route. Even when a respirator is used, prudent industrial and laboratory practices dictates that skin contact be avoided. The Office of Research Safety has information on the protection afforded by various gloves and disposable clothing materials.

5. Emergency Use Respirators: Respirators which are issued to the individual employee and kept as new stock for issue to the employee as a personal respirator, are not covered by this paragraph. Other respirators that are not routinely used, but are kept ready for emergencies are considered emergency use respirators. These include all Fire Department supplied air respirators. Supervisors are responsible for maintaining an inspection program for emergency respirators that includes having the respirator(s) inspected after each use and at least monthly to assure that they are in satisfactory condition. A written record of such inspection dates and findings must be kept by the supervisor. SEE ALSO SECTION VII ON EMERGENCY SITUATIONS. Supervisors of functions that have or are planning on having respirators for emergency use shall notify the Office of Research Safety (x2723).

6. Oxygen Deficiency Atmosphere: Atmosphere supplying respirators must be used in oxygen-deficient atmospheres (where oxygen is less that 19.5%). Typically, such environments also are covered by the UCHC Permit Required Confined Space Policy. If the atmosphere may contain less than 16% oxygen, a full facepiece pressure demand self-contained breathing apparatus or full facepiece pressure demand airline respirator with auxiliary self-contained air supply shall be used. Only properly trained emergency fire personnel shall don such respirators.

7. Maintenance of Respirators: Respirator maintenance will be limited to procedures conducted in accordance with manufacturer instructions with any parts being identical in make and size specified by the original manufacturer for the specific respirator.

IX. AIR SUPPLIED RESPIRATORS OF THE UCHC FIRE DEPARTMENT:

The above procedures are generally applicable to air supplied respirators. However, many other OSHA requirements may have to be considered for supplied air respirators. Thus, except for the UCHC Fire Department, any department or supervisor planning to use an air supplied respirator must contact the Office of Research Safety for a respirator safety assessment. The Office of Research Safety will review the hazard(s) and provide specific use and training recommendations to the department. These specific recommendations must be complied with and will form for that department an addendum to these procedures.

The UCHC Fire Department will establish their own written procedures for their respirator training, fit testing, respirator inspections, supervisor program reviews and use of self-contained breathing apparatus consistent with OSHA requirements. Their medical qualification to use a respirator will be from EHS. Their SCBA respirators are for emergency use and written records will be kept of at least monthly inspections of each such respirator. The Fire Department will maintain documentation that demonstrates the compressed air used meets breathing air quality standards. They will coordinate the use of any air-purifying industrial respirators (see Appendix A and B) in advance with the Office of Research Safety.

X. STUDENTS:

The above guidelines will generally apply to students, except those voluntarily wearing a respirator in an atmosphere known to be below established occupational health limits (e.g. formaldehyde exposures in anatomy laboratory).

XI. CHANGES:

Recommendations for changes to these procedures should be addressed to the Office of Research Safety(MC-3930, x2723).

XII. ENFORCEMENT:

Failure to comply with these requirements may result in disciplinary action up to and including termination of employment.

XIII. APPENDIXES:

A. Respirators For TB Respiratory Isolation

B. Respirator User Form Industrial/General Industry Use of Respirators

C. PAPR Use for First Receivers

D. Information For Employees Using Respirators When Not Required Under the Standard

RECOMMEND APPROVAL:

_______________________________ ___________________________________

Kenneth W. Price, Director Marcia Trapé-Cardoso, M.D., Director

Office of Research Safety Employee Health Service

_______________________________ ___________________________________

Daniel Penney, Associate Vice President Leonard Paplauskas, Associate Vice President

Facilities Management for Research Administration

__________________________________

Steven Strongwater, M.D., Associate Dean

Clinical Affairs, Director, Clinical Operations

Hospital Director

APPROVED:

___________________________________

Peter J. Deckers, M.D.

Executive Vice President

For Health Affairs, UCHC

Dean, UConn School of Medicine

Murray-Heilig Chair and Professor in Surgery

UConn School of Medicine

RESPOLCY2005

APPENDIX A

SELECTION AND USE OF RESPIRATORS FOR PROTECTION AGAINST TUBERCULOSIS EXPOSURE

(rev. 5/2006)

I. INTRODUCTION:

This Appendix provides summarized details of the University of Connecticut Health Center’s program for the selection, fit testing and issuing of respirators for protection against exposure to tuberculosis. A formal policy exists separate from this document entitled “University of Connecticut Health Center Tuberculosis (TB) Risk Assessment and Policy for the Control of Occupational Exposure to Tuberculosis”. This policy is based on recommendations from the Centers for Disease Control. Following CDC recommendations, it has been determined that the UCHC is a low risk facility based on CDC criteria of fewer than 6 cases per year. As a result of this risk analysis, certain target groups have been identified as staff with potential for exposure to TB. These target groups are as follows

Anatomic Pathology (Autopsy Only)

Cardio/Pulmonary Service

Emergency Department

Cardiac Stepdown

Intensive Care Unit

Infectious Disease Clinic

Psych 1

Med 4

Surg 5

Oncology 6

Surg 7

Geriatric Psych 3

Transportation Aids

Respiratory

Diagnostic Radiology

Correctional Health Care

Laboratory Medicine (Phlebotomists)

Facilities Management (ECC)

Housekeeping (Supervisors only).

Managers in these groups are responsible for ensuring potentially exposed individuals are compliant with the TB Policy. Entry into a TB isolation room or an area performing research with infectious TB is prohibited unless an individual is properly trained, medically cleared, has been fit tested and is wearing a NIOSH approved respirator.

II. SELECTION OF RESPIRATORY PROTECTION

The Occupational Safety and Health Administration withdrew the TB standard on Occupational Exposure to Tuberculosis (29CFR 1910.139) on December 31, 2003. As a result of this action, medical facilities wishing to issue respirators to staff for control of potential exposure to TB had to comply with the General Industry Respiratory Protection Standard (29 CFR 1910.134). Ramifications of this revocation were significant, including eliminating the use of irritant smoke for fit testing, annual retraining, annual medical clearance and annual refitting of respirators. Congressional action followed and on December 22, 2004, Congress passed the Consolidated Appropriations Act (FY 2005 budget bill) that forbid OSHA from utilizing any of its funding to enforce the annual fit testing requirements. Because there was a considerable period from the withdrawal of the TB standard in the action taken on December 22, 2004, many of the requirements in the Respirator Standard were applied to the UCHC TB Control Program. The current program reflects the requirements of the full respirator standard with the condition that annual fit testing will be suspended until such time that OSHA clarifies the requirements. The UCHC is prepared to institute a yearly medical evaluation and fit testing if required. Annual fit testing is voluntary as of the writing of this policy.

All respirators must be NIOSH certified, and must be N95 HEPA masks. Fit testing is done using the Bitrex procedure as provided in the OSHA Respirator Standard. Other OSHA approved procedures may be used if necessary.

Those individuals who cannot be fitted with an approved respirator or for various other reasons have not been issued a NIOSH approved respirator, a PAPR (Powered Air Purifying Respirator) must be used to enter an isolation area. PAPR’s must be NIOSH approved and individuals trained in their use.

Information concerning types of respirators, fit testing and training may be obtained from the Office of Research Safety (x2723) or the Department of Epidemiology, Infection Control (x4376).

III. PROCEDURE FOR OBTAINING A RESPIRATOR-TUBERCULOSIS

The follow actions need to be taken to obtain a respirator.

1. Your immediate supervisor must instruct you to obtain a respirator. If you wish to be issued a respirator obtain a verbal approval from your supervisor.

2. Obtain a “Respirator Medical Evaluation Questionnaire”. This confidential form must be completed and MAILED to the Employee Health Service, Dr. Marcia Trapé-Cardoso, MC6210. DO NOT FAX!! This form may be obtained from the Office of Research Safety (x2723) or downloaded from the Office of Research Safety Website. To download a copy, go the UCHC homepage, click on Research Administration, click on Office of Research Safety, scroll down to the medical questionnaire. This form cannot be emailed.

3. The Employee Health Service (EHS) will evaluate the contents of the form and may require you to visit their office. Once you have been cleared by the EHS a clearance form will be sent to the Office of Research Safety who will perform fit testing and training. Allow a week for this process.

4. Call the Office of Research Safety (x2723) to schedule a fit test and training. Verify you have been medically cleared. The Office of Research Safety will not perform a fit test without the medical clearance.

5. The fit test should take about 10 minutes, and the training session about 30 minutes. You will be issued a respirator specific to your facial type. An example “Respiratory Training and Fit Testing Protocol” form is attached.

6. If you cannot be fit tested, you may not enter a TB isolation room.

7. For those failing a respirator fit test, the only option for entering an isolation room or area is to don a PAPR. Training is required prior to wearing a PAPR and the Office of Research Safety can assist.

IV. ANNUAL RESPIRATOR FIT TESTING/MEDICAL CLEARANCE

As of the writing of this document, the OSHA rule that requires annual medical clearance and fit testing is not being enforced. The UCHC does have a system in place for annual fit testing, refresher training and medical clearances. This has also been put on hold as a mandatory program, but staff can request refitting. Refitting is highly recommended for those who had a facial trauma or surgery (including new dentures) and significant body weight changes (more than 10 lbs). Should OSHA begin enforcing the annual fitting rule and/or if an employee requests a refitting, the following procedure will be initiated.

VOLUNTARY REFITTING

1. Contact Office of Research Safety at x2723. Request a “Periodic Respirator Questionnaire after Initial Medical Clearance” form. This form is attached.

2. Complete the form and if all answers are “no” schedule an appointment with the Office of Research Safety. Bring the form with you. Any “yes” answer requires that you MAIL the form to the Employee Health Service, Dr. Marcia Trapé-Cardoso MC6210. You cannot be refitted until the Employee Health Service forwards a medical clearance to the Office of Research Safety.

3. Report with your respirator for a refit after medical clearance is obtained.

4. Refresher training will be provided during the fit test.

MANDATORY REFITTING

If OSHA begins to mandate refitting, then the following procedure will be implemented in addition to the Voluntary Refitting discussed above.

1. The Office of Research Safety will send a notice to each individual approximately 11 months after the initial fit test. This notice will provide the OSHA requirements and instructions for obtaining a refit. Under certain circumstances the Office of Research Safety will perform fit testing in the employee’s area of work if an adequate number of individuals will be fitted.

2. Obtain a “Periodic Respirator Questionnaire after Initial Medical Clearance and Fit Testing” form from the Office of Research Safety (x2723). If a mass fit testing session is scheduled for your work group, the Office of Research Safety will provide forms at that time.

3. If any answer on the Medical Questionnaire is “yes”, a fit test will not be performed without written approval from the Employee Health Service. See section “VOLUNTARY REFITTING” for details.

V. OBTAINING A RESPIRATOR/INFORMATION

You should have the respirator you were fitted with readily available. If you do not have a respirator one can be obtained. Respirators are available through the UCHC Warehouse, and must be made available at no charge to the employee. Target Group managers should have respirators on hand. The Office of Research Safety has a limited supply of respirators for emergency situations. Always wear the exact type of respirator you were fitted with. Never use another person’s respirator. The Office of Research Safety can tell you what type of respirator you should wear.

The UCHC Environmental Control Center (x2338) maintains a limited number of PAPRs for use by the ECC staff and other’s needing such a unit. In order to obtain a PAPR

1. Call the ECC at x2338 (available 24/7) and inform them you are in need of a PAPR. Depending on the workload, the PAPR may be delivered to your location. Anticipate that you will have to pick one up. During normal work hours, call the Office of Research Safety at x2723.

2. Go to the ECC and sign out a PAPR.

3. Follow Instructions on the packaging.

4. Return to the ECC when not needed.

VI. CONTACTS

The Departments below can be contacted for information.

Infection Control x4376

Employee Health Service x2893

Environmental Control Center x2338

Office of Research Safety x2723

Appendix A-Attachments

Respirator Medical Evaluation Questionnaire

TB Respiratory Isolation (RI) Respiratory Training and Fit-Test Protocol

Periodic Respirator Questionnaire after Initial Medical Clearance and Fit Testing

:TBrespPro

Respirator Medical Evaluation Questionnaire

Please complete the Sections of this questionnaire that apply to you. If you have medical questions call Employee Health Service at 679-2893. For questions regarding respirator fit test appointments, call the Office of Research Safety at x2723.

TO THE EMPLOYEE:

Can you read (circle one): Yes No Respirator Category (circle one): Required Voluntary

Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it. Return this questionnaire to Dr. Marcia Trapé-Cardoso, Medical Director, Employee Health Service, MC6210. DO NOT FAX.

Part A. Section 1. (Mandatory) The following information must be provided by every employee who has been selected to use any type of respirator (please print).

1. Today's date:____________________________

2. Your name:_________________________________________________ SSN: _______ - ____ - _______

3. Your date of birth:______________________________

4. Sex (circle one): Male/Female

5. Your height: __________ ft. __________ in.

6. Your weight: ____________ lbs.

7. Your job title:____________________________________ Department/Work Area: _____________________

Have you contacted the Office of Research Safety about Respiratory Requests (circle one): Yes No

8. A phone number where you can be reached by the health care professional who reviews this questionnaire (include the Area Code):_____________________________________

9. The best time to phone you at this number: ________________

10. Has your employer told you how to contact the health care professional who will review this questionnaire (circle one): Yes No

11. Check the type of respirator you will use (you can check more than one category):
a. ______ N, R, or P disposable respirator (filter-mask, non- cartridge type only).
b. ______ Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air, self- contained breathing apparatus).

12. Have you worn a respirator (circle one): Yes No

If "yes," what type(s): _______________________________________________________________________________________

Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please circle "yes" or "no")..

1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes/No

2. Have you ever had any of the following conditions?

a. Seizures (fits): Yes/No

b. Diabetes (sugar disease): Yes/No

c. Allergic reactions that interfere with your breathing: Yes/No

d. Claustrophobia (fear of closed-in places): Yes/No

e. Trouble smelling odors: Yes/No

3. Have you ever had any of the following pulmonary or lung problems?

a. Asbestosis: Yes/No

b. Asthma: Yes/No

c. Chronic bronchitis: Yes/No

d. Emphysema: Yes/No

e. Pneumonia: Yes/No

f. Tuberculosis: Yes/No

g. Silicosis: Yes/No

h. Pneumothorax (collapsed lung): Yes/No

i. Lung cancer: Yes/No

j. Broken ribs: Yes/No

k. Any chest injuries or surgeries: Yes/No

l. Any other lung problem that you've been told about: Yes/No

4. Do you currently have any of the following symptoms of pulmonary or lung illness?

a. Shortness of breath: Yes/No

b. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes/No

c. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes/No

d. Have to stop for breath when walking at your own pace on level ground: Yes/No

e. Shortness of breath when washing or dressing yourself: Yes/No

f. Shortness of breath that interferes with your job: Yes/No

g. Coughing that produces phlegm (thick sputum): Yes/No

h. Coughing that wakes you early in the morning: Yes/No

i. Coughing that occurs mostly when you are lying down: Yes/No

j. Coughing up blood in the last month: Yes/No

k. Wheezing: Yes/No

l. Wheezing that interferes with your job: Yes/No

m. Chest pain when you breathe deeply: Yes/No

n. Any other symptoms that you think may be related to lung problems: Yes/No

5. Have you ever had any of the following cardiovascular or heart problems?

a. Heart attack: Yes/No

b. Stroke: Yes/No

c. Angina: Yes/No

d. Heart failure: Yes/No

e. Swelling in your legs or feet (not caused by walking): Yes/No

f. Heart arrhythmia (heart beating irregularly): Yes/No

g. High blood pressure: Yes/No