8.1 – Respiratory Protection

In accordance with all applicable federal, state, and local regulations, as well as Temple University policy, Environmental Health and Radiation Safety Department (EHRS) oversees the respiratory protection program at Temple University. The program requires that the control of airborne contaminants must occur by accepted engineering control measures. These engineering controls should alleviate the necessity for application of respirators. However, if for whatever reason effective controls are not feasible, or while they are being instituted, appropriate respirators must be used. A respirator is defined as a device used to protect the wearer from inhalation of harmful contaminants. EHRS provides fit testing and training for those who are covered by the respiratory protection program.

Administrative Directors, chairpersons of academic departments and their equivalents are responsible for identifying all personnel under their supervision who require respiratory protection. Furthermore, these supervisors must identify potential work areas where potential respiratory protection is required. EHRS provides assistance in specifying the type of respiratory protection based on the nature and concentration of hazardous material, condition of use, and environmental factors. In addition, EHRS identifies activities such as welding, painting, or embalming, which may require respiratory protection.

No occupational health and safety program is effective unless the affected employees are aware of it and are willing to implement it when and where required. Employees are required to wear the appropriate respiratory equipment according to relevant instructions, and to maintain the equipment in a clean and operable condition.

8.2 – Respiratory Protection and Engineering Controls for Tuberculosis

Introduction

Purpose

This chapter has been developed to inform, train and minimize the risk of possible Tuberculosis (TB) transmission to health care workers who need to enter a TB isolation room.

Applicability

This chapter is applicable to all Temple University Health Systems.

Respiratory Protection

Environmental Health and Safety (EHS) has established an effective Respiratory Protection Program to evaluate and train health care workers on how to use the proper respiratory protection and personal protective equipment (PPE), including medical screening to prevent TB exposure. Health care workers who are in direct contact with a known Tuberculosis patient Specifically those entering a TB isolation room must be trained and/or fit tested with the proper respiratory protection and PPE.

Personal Protective Equipment

The National Institute of Occupational Safety and Health (NIOSH) approves the N95 disposable respirator for protection against TB. This respirator is able to filter the particles of 1-5 microns in size from teha ir to prevent entry into the respiratory track if the respirator is worn properly. The employee must be fit tested with the N95 respirator in order to issue proper sizing. Whenever a tight seal cannot be achieved (e.g. facial hair), the Powered Air Purifying Respirator (PAPR) must be used. Fit testing is not performed for this style of respirator however it is important that all personnel are properly trained before using the PAPR unit. Users must inspect the N95 or PAPR respirator don surgical scrubs and gloves before entering the isolation room.

Patient Transportation

Known TB patients must wear a surgical mask while being transported. The surgical mask does not have to be a N95 respirator, nor does the patient have to be fit tested.

Risk Assessment

It is mandatory that certain departments whose personnel have a higher risk of Tuberculosis exposure receive training and fit testing for the proper respirator. Risk groups are defined as follows:

1.High Risk -- Departments whose personnel are at high risk for TB exposure, such as the Emergency Department, Infectious Diseases, and Pulmonary Department must be trained and fit tested for the proper respirator prior to entering a TB isolation room.

2. Medium Risk - Health Care workers such as Residents may need to be fit tested for a proper respirator if they enter an isolation room.

3. Low Risk - Personnel who have little contact with TB patients, departments such as Nuclear Medicine, Diagnostic Imaging, who from time to time may have a known TB patient in their area are not required to be fit tested.

Engineering Controls

Isolation rooms require a certain amount of engineering controls in order to house a patient with Tuberculosis. Ventilation can greatly reduce the spread of airborne contaminants (TB microorganisms). Isolation rooms must be at negative pressure to adjacent areas.

If the proper procedures and engineering controls are followed it will greatly reduce or possibly eliminate any occupational exposure to Tuberculosis.