Appendix C
C-100 TUBERCULOSIS EXPOSURE CONTROL PLAN

TUBERCULOSIS SURVEILLANCE PROGRAM

and

EMPLOYEE RESPIRATORY PROTECTION PROGRAM

C-100.1 Exposure Control Plan

It has been recognized that the Olympia Police Department personnel, in the normal course of their duties, may come into contact with airborne pathogens, specifically tuberculosis, increasing the chance of contracting this potentially harmful or fatal disease. In accordance with WAC 296-62-071, the Occupational Safety and Health Act of 1970, and the Center for Disease Control’s “Guidelines for Preventing the Transmission of Tuberculosis in Health Care Settings” the Olympia Police Department has established the following procedures for its employees. In addition, the Department will provide appropriate information and follow up care if exposure should occur, and will educate Department personnel on the modes of transmission, etiology (the study of the cause of disease), and precaution methodologies against tuberculosis.

This document describes the Tuberculosis Surveillance Program and its administration. On going surveillance of employees will be done to detect any exposure to tuberculosis and treat any employee who becomes infected.

This document also describes the employee Respiratory Protection Program. Specific employees will be required to have training in the use of respirators to prevent the spread of tuberculosis.

C-101 Administration of programs

The Support Services Commander is responsible for overall administration of the programs, and will approve the use and selection of respirators.

The Support Services Commander will monitor the Tuberculosis Surveillance Program, and will ensure that all employees are tested and provided with follow up care as needed.

The Support Services Commander is responsible for the ensuring that appropriate respirators are provided, and that they are properly used and maintained.

The Support Services Commander will review the effectiveness of the airborne pathogen program yearly prior to the annual training. This evaluation shall be documented and reviewed by the department’s safety committee.

C-102 Occupational exposure to tuberculosis

C-102.1 Exposure Control

1.    The Thurston County Health Officer will assess, on a yearly basis, the overall risk of Tuberculosis in Thurston County. This will include trend data on the number of active cases, trend data on the number of skin test conversions, and sociodemographic groups at highest risk.

The Thurston County Health Officer has determined our county’s tuberculosis risk level to be low.

The tuberculosis risk is higher in the following national subpopulations according to the Center for Disease Control:

*    Persons with HIV infection

*    Close contacts of infectious tuberculosis cases

*    Persons with medical conditions which increase the risk of tuberculosis

*    Foreign-born persons from high prevalence countries

*    Low-income populations, including high risk minorities

*    Alcoholics and intravenous drug users

*    Residents of long-term care facilities i.e., health care settings, correctional institutions, homeless shelters, convalescent homes, and drug treatment centers.

C-102.2 Employee Assessment

The following job classifications can reasonably anticipate occupational exposure to tuberculosis:

EMERGENCY RESPONDERS/PATIENT CARE PROVIDERS:

Sworn Titles

Civilian Titles

Police Officers

Property/Evidence Personnel

Detectives

Reserve Police Officers

Sergeants

Detention Officers

Lieutenants

Police Service Assistant

Commanders

 

Chief of Police

 

The following job classifications are considered required to wear respirators:

RESPIRATOR USERS:

Detention Officers

Police Services Assistant

Detectives

Evidence Technician

The following job classifications are not to have occupational risk of exposure to tuberculosis however, they will receive general tuberculosis training and offered skin tests. In the event of tuberculosis exposure they will receive the same after care provided to Emergency Responders/Patient Care Providers.

COLLATERAL EMPLOYEES:

Public Service Representatives

Data Technicians

Office Specialists

Secretaries

Victims’ Assistance Coordinator

Cadets

C-103 Training: initial training

The Thurston County Health Department will provide on-going initial training to all emergency responders in the county. The employee’s initial training will be completed during their orientation training.

C-103.1 Annual Training

The department will conduct annual refresher training with the aid of the Health Department or trained personnel within the department. The annual training will consist of two levels of training:

1.    General tuberculosis training explaining the etiology (the study of the cause of disease), the modes of transmission, and the precautions methodologies against tuberculosis.

2.    Respirator training/fit testing for employees required to wear a respirator during the course of their duties.

C-103.2 Training for trainers

The Health Department will provide training for departmental trainers if the department desires it’s staff to provide tuberculosis training to the department.

C-103.3 Respirator training

The department will provide respirator training for all respirator users whose job classifications have a risk of occupational exposure in confined spaces to Tuberculosis. The department has identified the jail and an autopsy room to be confined spaces.

C-104 Definitions

1.    TUBERCULOSIS: (general) Tuberculosis is a systematic disease most commonly affecting the lungs. However, tuberculosis may also occur in any other body organs or tissue, but Pulmonary Tuberculosis is the only infectious type. The etiological agent of tuberculosis, Mycobacterium Tuberculum, is carried through the air in infectious droplets which are produced when a person with active tuberculosis sneezes, coughs, speaks or sings. When people breathe the air contaminated by an infectious patient, they may become infected with the tuberculosis bacillus. Ventilation is important in the reduction of viable organisms in a given space. Covering the patient’s mouth will reduce the number of organisms excreted into the air. Respirators may prevent inhalation of any airborne organisms. Effective anti tuberculosis therapy quickly eliminates a large number of a patient’s bacilli and renders most patients non infectious after two weeks of medication. Tuberculosis bacilli enter the lungs and establishes an infection. The tuberculin skin test is used to identify persons who have been infected. The skin test will show positive within 2 10 weeks after exposure. Individuals who are infected but show no clinical signs or symptoms are not considered contagious. An average of 1 in 10 infected persons will develop the active state of the disease in their life time if not treated.

TUBERCULOSIS SYMPTOMS ARE:

-Productive cough of greater than 3 weeks duration;

-Coughing up blood;

-weight loss;

-loss of appetite;

-lethargy (more than usual tiredness)/weakness;

-night sweats;

-fever

2.    UNDETERMINED TUBERCULOSIS: An undetermined case of tuberculosis will be when a person states they have TB and/or had a positive skin test and are unable to show medication or any information to document this information.

3.    SUSPECTED TUBERCULOSIS: A suspected case of tuberculosis will be when an individual has 5 or more symptoms associated with TB.

4.    CONFIRMED TUBERCULOSIS: (infectious case) A confirmed/infectious case of tuberculosis will require either the Health Department or their private physician to confirm they have a culture positive result for Mycobacterium Tuberculosis.

5.    OCCUPATIONAL EXPOSURE: Means confined space contact with an unconfirmed case that later is determined to be infectious, suspected or confirmed case of Tuberculosis.

6.    CONFINED SPACE: A work area with limited natural or mechanical ventilation that presents a hazard of accumulation of air contaminants or oxygen deficiency.

7.    OXYGEN DEFICIENCY: A condition in which the concentration of oxygen in the air is less than 19.5 percent.

8.    PARTICLE MASK: Also known as a surgical mask. Any preformed nose and mouth cover used to keep exhaled pathogens from being spread around the surrounding area or prevent the inhalation of large particles. These masks will not prevent the inhalation of Tuberculosis bacterium, they are used to reduce the aerosolization of the Tuberculosis bacterium.

9.    RESPIRATOR: An approved respiratory device that prevents the inhalation of harmful airborne contaminates.

C-105 Tuberculosis surveillance program

Screening for tuberculosis will be done to identify employees who would benefit from preventive therapy. Screening is recommended for all emergency responders/patient care providers and respirator users. These employees are considered patient care personnel. The Mantoux method of testing will be administered by the Thurston County Health Department. Employees identified under the Collateral definition are not required to be skin tested however, we will offer skin testing to them at no cost.

Emergency responders/patient care personnel, including respirator users, are required to undergo annual skin testing. All patient care personnel are subject to the Tuberculosis Surveillance Program upon employment. Results of the skin testing will not effect the persons employment.

1.    Initial Skin Testing:

Upon employment, all individuals involved in emergency response/patient care positions are subject to the Tuberculosis Surveillance Program. The initial skin testing will be done during the employee’s orientation training. Employees will be required to participate in the Tuberculosis Surveillance Program, unless they can provide medical proof they have tested positive for TB in the past.

2.    Subsequent Annual Skin Testing:

Personnel in emergency response/patient care positions are required to receive annual skin tests. The annual skin tests will be administered on the employee’s anniversary hire date.

C-106 Screening and history

1.    Administration:

The Thurston County Health Department will administer the Tuberculosis Surveillance Program:

A.    The Mantoux method skin test will be used. Tests must be read 48 72 hours after administration.

B.    Parental consent is required for minors; those under 18 years of age.

C.    Employees may present documentation of previous negative skin test(s) if they were administered within the previous three months in lieu of skin test upon employment.

D.    Employees 35 years of age and older may be requested to have a second skin test 1 3 weeks after the first test.

E.    Induration less than 10 mm is a non significant reaction, unless the patient has had close recent contact with a patient with infectious tuberculosis; someone with chest radiographs with fibrotic lesions likely to represent old healed tuberculosis or a person with known or suspected HIV infection.

F.    Written documentation of administered skin test results will be provided to each new employee.

2.    Significant (Positive) Skin Test Reactions:

Employees with significant reactions to skin test must take a chest x ray within 30 days.

3.    Record keeping:

Records of TB testing will be maintained on each employee by the City of Olympia personnel office in accordance with WAC section 296-62-052.

C-107 Olympia Police Department and emergency medical interaction with tuberculosis patients

The Thurston County Health Department has determined that risk of exposure to tuberculosis in this county is low. Therefor the following guidelines will be used to control the interaction between the emergency responders and the tuberculosis patient. The Thurston County Health Department will complete a yearly review of the overall risk of tuberculosis and modify these guidelines as needed.

The following groups of responders will be covered under the Health Department’s guidelines.

1.    Firefighters / EMTs / First Responders non transporting

2.    Police Officers transporting

3.    Paramedics / EMTs transporting

4.    Correction Officers/Detention Officers - housing

Firefighters / EMTs / First Responders that are not trained in the use of respirators will be allowed to enter the residence, evaluate and drive an UNDETERMINED CASE of tuberculosis patient to a receiving facility without respiratory protection. It is recommended that as soon as the patient is identified as an UNDETERMINED CASE that the patient be given a particle mask to wear and if possible the patient is moved to an area of fresh air. These responders are instructed to remove themselves from the area of any suspected or confirmed case that has not been on medication for tuberculosis for more than three months or have not had three consecutive negative sputum tests. These responders are instructed to await the arrival of personnel trained in respirator use before patient treatment can proceed. These personnel can not drive a transporting unit to a receiving facility.

Police officers that suspect they may be dealing with an UNDETERMINED CASE of tuberculosis should ask the patient questions to get more information about their health. Police Officers should inquire if the patient is experiencing coughing, weight loss, fever and night sweats, and/or lethargy. If some or all of these symptoms appear present, the officer shall give the patient a particle mask and move them to a well ventilated area, preferably outside. Police officers that are not trained in the use of respirators will be allowed to enter the residence, evaluate and drive an UNDETERMINED CASE tuberculosis patient to a receiving facility in a police cruiser without respiratory protection. It is recommended that the windows of the police cruiser be opened and the non-recirculating fan be set on high to allow circulation of fresh air into the vehicle.

Police officers are instructed to remove themselves from confined spaces where a SUSPECTED OR CONFIRMED case is that has not been on medication for tuberculosis for more than three months or have not had three consecutive negative sputum tests. These responders are instructed to get the person outside or to await the arrival of fire department personnel trained in respirator use before patient interaction can proceed.

Transportation of this person will require that the driver be trained in the use of, and be wearing a respirator. In the event that an arrest is required of a person with a SUSPECTED OR CONFIRMED case of tuberculosis, the Watch Commander will ensure the Thurston County Health Officer is conferred with prior to transporting the individual. The individual may need to be taken to a health care facility. Transporting the individual will require an ambulance. The need to incarcerate the individual shall be weighed carefully by the Watch Commander. Generally speaking, felony arrests will be considered if they involve acts of violence. Hospitalization instead of jail is recommended to determine the infectiousness of the individual.

Misdemeanor in-custody arrests should not be allowed to occur.

Paramedics / EMTs that transport patients and that are trained in the use of respirators will be allowed to enter the residence, evaluate and drive an UNDETERMINED CASE of tuberculosis patient to a receiving facility without respiratory protection. It is recommended that as soon as the patient is identified as an UNDETERMINED CASE of tuberculosis that the patient be given a particle mask to wear and if possible the patient is moved to an area of fresh air. The attendant Paramedic / EMT that accompanies the possible tuberculosis case in the patient compartment of a transporting vehicle shall be trained in the use of, and be wearing a respirator. The front windows of the transporting vehicle shall be open and the exhaust fans shall be operating. Paramedics and EMTs trained in the use of, and wearing a respirator will be required to evaluate, drive the transporting unit and be in attendance in the patient compartment with any patient that has suspected or confirmed tuberculosis and has been on medication for less than three months or have had three consecutive negative sputum tests.

The following medications should raise suspicion that the patient is being treated for tuberculosis. Any patient currently being treated should be considered a potentially infectious exposure unless the medication has been taken for more than two weeks. Medications used to treat tuberculosis may include the following and will be Prescribed in pairs not singularly:

1.    isoniazid (I.N.H.)

2.    rifampin

3.    pyrazinamide

4.    ethambutol

5.    capreomycin

6.    kanamycin

7.    ethionamide

8.    para amino salicylic acid

9.    cycloserine

10.    rifamate

Correction Officers/Detention Officer/Police Service Assistant contacts with UNDETERMINED, SUSPECTED OR CONFIRMED cases of tuberculosis:

Every person brought into the Olympia City Jail shall be medically screened to ensure the medical needs of the prisoner as well as to ensure the safety of our personnel. The Detention Officer shall interview the prisoner and complete a medical screening form as soon as possible after the prisoner’s arrival. The Detention Officer shall not accept a prisoner with SUSPECTED OR CONFIRMED tuberculosis. If the prisoner is under arrest for a felony involving violence the prisoner shall be hospitalized and checked for infectiousness or released after conferring with the Prosecutor’s office. This shall occur only after the Watch Commander confers with the Thurston County Health Officer on the housing requirements and medical needs of the person arrested. People under arrest for misdemeanors will not be allowed to be booked, printed or processed into our jail.

In the event of UNDETERMINED CASES of tuberculosis the Detention Officer shall notify the Watch Commander of the circumstances that brought us to the determination we were dealing with an UNDETERMINED CASE of tuberculosis. The Detention Officer shall confer with the Watch Commander on the need to house such a prisoner in our jail. The prisoner, if housed, shall be asked to wear a surgical mask at all times during their time at our jail. The prisoner shall be separated from the rest of the jail population and placed in a separate cell. A “Respiratory Precaution” sign shall be placed on the door of the cell. ANY AND ALL contact with the prisoner, including meals, shall be done by a Detention Officer after having donned their 3M 9970 Respirator. A report shall be forwarded to the Jail Administrator documenting the circumstances of the incarceration including the time the individual arrived in the jail, the time they may have been in our jail unsegregated from the population, and the names of all people who had contact with the individual while at the Olympia City Jail. Within 24 hours, the Support Services Commander shall ensure the inmate is taken to West Care Clinic for an evaluation. The Health Department will be forwarded information regarding the individual. After the individual leaves our facility, the cell they occupied shall be air out for one hour using a portable fan before using the cell for another person. All bedding and mattresses shall be removed and cleaned.

C-108 Requirements and responsibilities in the event of an occupational exposure

The City of Olympia and the Olympia Police Department are responsible for establishing policies and procedures which maximize the protection against communicable diseases for all its employees, as well as the public they serve. These policies and procedures shall meet the requirements of OSHA’S OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970, the CENTER FOR DISEASE CONTROL’S “GUIDELINES FOR PREVENTING THE TRANSMISSION OF TUBERCULOSIS IN HEALTH CARE SETTINGS”, AND WAC 296-62-071. The Department shall ensure compliance with these policies and procedures with emphasis on the training of employees in the rational application of exposure control practices. In addition, the Department will make available to employees the preventive and protective measures required by these policies and procedures in order to minimize the risk of exposure and provide the treatment and evaluation for any employee experiencing an accidental occupational exposure.

To afford maximum protection to personnel who are inadvertently exposed to a patient with UNDETERMINED, SUSPECTED OR CONFIRMED Tuberculosis the following procedure will be followed to provide for the occupational health and safety of employees.

C-108.1 Responsibilities of Department personnel who experience an occupational exposure incident

1.    Shall report all suspected contacts to their immediate supervisor. The employee shall complete the department’s Communicable Disease Report form. The Support Services Commander shall ensure the employee contacts Westcare Clinic or their private physician for a TB skin test. Additional follow-up tests or counseling shall be provided to the employee if medically indicated. The Health Department will contact and test the source patient to determine if the source person was infected and/or infectious. The Health Department will assess whether each case is an Occupational Exposure incident. The Support Services Commander shall ensure the employee receives the Health Department’s assessment on the necessity of additional follow-up care.

2.    Employees who have a history of non significant (negative) skin tests.

A.    All suspected Occupational Exposures will have a skin test done within 72 hours of the incident. The Support Services Commander will ensure the Health Department has the name of the source patient for their follow-up investigation.

B.    If skin test remains non significant (negative), after 10-12 weeks from the exposure, no further action is required

3.    If skin test becomes significant, the employee will receive a chest x ray within 30 days and be referred to West Care Clinic or their personal physician, Infectious Disease Specialist and/or Pulmonologist for treatment and follow up.

4.    Employees who have had a previous significant (Positive) skin test:

A.    Employees taking or having completed a course of prophylactic medication need take no further action.

B.    Significant reactors who have had two negative chest x rays need take no further action.

C-108.2 Responsibilities of immediate supervisors

The supervisor will have the employee complete the department’s Communicable Disease Report form and the Cities Injury/Accident Report form. Please include the method of contamination and the length of exposure on the Communicable Disease Report form. The supervisor shall forward the reports to the Support Services Commander.

C-108.3 Responsibilities of the Support Services Commander

1.    Shall contact the Thurston County Epidemiology office, 786-5470, with the following facts and circumstances of the incident:

A.    Name, title and phone number of person managing the case for the department.

B.    Name of staff person possibly exposed.

C.    Name, address, phone number and birth date of suspected source case.

D.    Date and location of exposure.

E.    Status of the source case e.g. in jail, transported to... or released.

The Health Department staff will research the source case and help determine if an exposure really occurred and get back to the department on their next working day.

The Support Services Commander shall ensure the employee receives the Health Department’s assessment of the incident. The employee shall be directed to go to the Westcare Clinic, on duty time, for post exposure follow-up care and counseling.

2.    Shall ensure that all medical evaluations and procedures including counseling are made available at no cost to the employee and at a reasonable time and place.

3.    Shall ensure that all employees required to participate in the Tuberculosis Surveillance Program be skin tested annually. The Support Services Commander shall ensure the employee receives a skin test at no cost to the employee.

4.    Shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided a copy of the Communicable Disease Report and a description of the exposed employee’s duties as they relate to the exposure incident, and all medical records relevant to the appropriate treatment of the employee including skin test results from the Health Department.

5.    Shall make available counseling for the employee and their family regarding the implications to the employee’s personal and professional life.

6.    Shall ensure the City of Olympia Risk Manager is made aware of the exposure incident.

C-108.31 Record keeping responsibilities of the Support Services Commander

1.    Shall ensure the accurate recording of all exposure incidents and all post exposure follow up procedures of the department.

2.    Shall maintain a record of all exposure incidents of employees of the department for review purposes only. The records shall be limited to incident date, employee job classification, type of exposure, facts describing how the exposure took place, and documentation of post exposure follow up.

3.    Shall conduct a review of the exposure control plan and all occupational exposures annually. The review shall be prior to annual training of our exposure control plan. It shall consist of, but not limited to, an examination and maintenance or replacement of engineering and work practice controls. The Support Services Commander shall ensure any changes in work practice or engineering controls get incorporated in the annual training.

4.    For the purpose of preservation, in accordance with WAC 296-62-05207, the Support Services Commander shall ensure all records with respect to occupational exposure are forwarded to the employee’s personal file located in the cities Personnel Office. The Support Services Commander shall seal all records of an occupational exposure in an envelope and mark it “CONFIDENTIAL”.

5.    Shall maintain the confidentially of all records relating to occupational exposure and ensure they are not disclosed or reported without the employee’s expressed written consent to any person or agency except as required by law. The availability of any record of an occupational exposure shall be strictly governed in accordance with WAC 296-62-052.

C-109 Employee respiratory protection program

1.    Policy:

Whenever possible, ventilation and enclosures will be used to protect employees from airborne contaminants. But when these controls are not feasible, respirators will be used to protect employees. This plan has been developed in accordance with good industrial hygiene practice and the requirement of OSHA and State OSHA programs.

2.    Purpose:

The purpose of this written program is to establish procedures regarding use of respirators for personal protection against airborne contaminants and to provide for ongoing tuberculosis surveillance within tho Olympia Police Department.

3.    Scope:

This program applies to respirators used for employee protection from airborne pathogens only, specifically tuberculosis. Surgical masks approved by the FDA for patient safety are not addressed by this program because surgical masks were developed for patient safety and have not been tested by the same protocols. Self contained breathing apparatus are not addressed or covered in this document.

C-109.1 Respirator Availability and Selection

Only respirators approved by NIOSH/MSHA will be used. Current guidelines require a H.E.P.A. (high efficiency particulate air) respirator to be used. At the present time the department is using the 3M Model 9970 Respirator which is a H.E.P.A. respirator and is approved by NIOSH/MSHA.

No employee will use a respirator for protection against an airborne contaminant without FIRST undergoing medical screening, training, and fit testing. The Olympia Police Department will supply appropriate respirators of appropriate size to all employees required to use respirators, free of charge.

Employees required to wear a respirator are:

1.    Detention Officers and Police Service Assistants assigned to the Jail:

Employees assigned to work in the jail with UNDETERMINED CASES of Tuberculosis are required to wear a respirator whenever they have contact with the prisoner. Respiratory Precaution signage shall be strictly adhered to. The jail is considered a high risk environment and a confined space.

2.    Detectives and Evidence Technicians:

Employee assigned to attend an autopsy are required to wear a respirator. Autopsy rooms are considered a high risk environment and a confined space.

C-109.11 Respirator Fit-Testing

The respirator must be fit tested, using the appropriate qualitative fit tests. The Saccharin fume test will be used to ensure proper fit of high efficiency particulate respirators. (see Appendix A). The Jail Administrator will ensure a trained quality fit tester will perform the fit testing for our employees required to wear a respirator in the performance of their duties. The department will retain testing documentation for the duration required for employee medical files.

C-109.12 Medical Screening for Respirator Wearers

Before wearing a respirator, employees will be medically screened, using a Respiratory Questionnaire, by the Jail Administrator. (see Appendix B). The purpose of the screening is to determine whether the individual has a medical condition or psychological difficulty (for example, claustrophobia) which contradicts using a respirator. If the Respiratory Questionnaire indicates a medical evaluation is needed, the employee will be referred to a physician for a medical evaluation. (See Appendix C.)

C-109.13 Employee Fit-test Training

This training will be given by a qualified Fit Tester for the particular respirator used. OPD’s trainer is the Jail Administrator.

Each respirator user will be shown how to wear a respirator, and will be trained in the following:

1.    Principles of respirator operation.

2.    How to put on and take off the respirator.

3.    How to perform positive and negative fit check.

4.    The purpose of the qualitative fit tests.

5.    How and when to detect a problem with a respirator, and to whom it should be reported.

6.    When to dispose of the respirator.

7.    Specific tasks for which a respirator is required.

8.    Limitations of the respirator.

9.    How to maintain, clean, and store the respirator.

10.    In class, hands on opportunity to wear the respirator.

Note: This training shall be repeated annually to conform with State regulations.

C-109.14 Record keeping

Records of training and fit testing will be kept in department’s Safety Committee and Training files and retained in accordance with the department’s policy for education and training records.

Also, to ensure that this training program is available at all times, copies will be distributed as follows:

1.    1 copy placed in the Department Safety Manual.

2.    1 copy kept in the training curriculum file.

3.    1 copy given to each respirator user.

C-109.15 Putting on the respirator

Proper fit is essential if employees are to receive the protection for which this program is designed. Air that passes around the respirator’s edges, rather than through it, is not filtered air.

1.    The respirator and straps must be in place and worn in the appropriate position. To adjust head bands, pull the free ends tight until a comfortable fit is obtained. All straps All straps shall be secure.

2.    To adjust face piece properly, position chin firmly in the chin cup and manually shift rubber mask until the most comfortable position is located. Make final adjustments to head band and do NOT break the nasal seal. Modifications to the respirator or straps shall NOT be made.

3.    According to the manufacturer’s instructions, PROPER FIT MUST BE CHECKED EACH TIME THE RESPIRATOR IS WORN. Respirators shall NOT be worn when projections under the face piece prevent a good seal; this includes conditions such as bread growth or sideburns.

NOTE: In the event that an employee is unable to obtain a satisfactory fit with the type of respirator provided, the department will make efforts to correct the problem by providing a different brand, style, or size of respirator.

C-109.15 Useful life of a respirator

Disposable particulate respirators shall be discarded when there is any concern about dirtiness and/or contamination. The tuberculosis that the respirator is designed to prevent the inhalation of is no longer a threat once it is pulled into the outside of the respirator. Any germs or viruses that the employee breaths into the inside of the respirator could remain active for some time and be passed on to another user. For this reason each respirator user will be given their own respirator for their personal use. If the respirator gets dirty or needs replaced the department will give the employee a new one.

C-109.16 Storage, cleaning, maintenance and inspection of respirators

1.    Respirators shall be stored in a way that protects them from dust, sunlight, extreme heat or cold, excessive moisture, damaging chemicals, and physical damage or distortion. They shall not be stored in such places as lockers or tool boxes unless they are in carrying cases or cartons. The storage locations shall be determined by the supervisor of each work area. Respirators can be placed in a closed paper bag or a closable plastic bag with air holes in it.

2.    The employee is responsible for proper cleaning and storage, and for routine inspection of the respirator they wear.

3.    Respirator inspections shall include:

A.    Tightness of connections

B.    Condition of face pieces

C.    Condition of headbands

D.    Condition of valves

E.    Test rubber or elastomer for pliability

F.    Test rubber or elastomer for deterioration

C-109.17 Respirator program evaluation

The effectiveness of this program will be evaluated by:

1.    Periodically observing employee activities to confirm proper respirator use.

2.    Periodically inspecting respirators in storage to ensure they are clean, in good condition, and properly stored.

3.    Observation of and discussion with employees to determine that the employee has adequate knowledge about respirator selection, use, limitations, and maintenance.

Program evaluation shall be documented and reviewed by the Safety Committee and the Support Services Commander.

C-110 Respirator fit-testing

The purpose of fit testing is to ensure that there is an adequate seal between the wearer’s face and the respirator. Without a good face seal, airborne chemical contaminants can enter the wearer’s respiratory system and thus not provide the wearer the needed protection.

1.    Positive and negative pressure tests (aka “fit check”):

The “fit check” is used every time the respirator is put on to assure the respirator is adjusted and worn properly. (Note: The fit check is not the same as the Saccharin fit test described below.) The negative pressure test is performed by covering the whole respirator lightly with the hands and inhaling slightly. If a leak exists, the air can be felt as it enters. The positive pressure test is performed by blocking the exhalation valve and exhaling lightly. Again, air leakage can be felt if a leak is evident. If such leaks are found, the respirator is adjusted and retested.

Neither the positive or negative pressure test is considered to be a satisfactory initial fitting test. These tests are to be used when donning a respirator; however, the position of the respirator on the face may be affected by touching the face piece to block the air inlets and exits.

2.    Qualitative fitting test:

The qualitative fit test is performed initially at the time a respirator is selected. The purpose is to determine that the specific size, brand, and model of respirator fits the individual. The department will use the following Qualitative Fit Test: The Saccharin Fit Test.

C-110.1 Saccharin solution aerosol protocol

1.    Taste threshold screening.

A.    Threshold screening as well as fit testing employees shall use an enclosure about the head and shoulders that is approximately 12 inches in diameter by 14 inches tall with at least the front portion clear and that allows free movement of the head when a respirator is worn.

B.    The test enclosure shall have a three-quarter inch hole in front of the test subject’s nose and mouth area to accommodate the nebulizer nozzle.

C.    The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the screening test.

D.    The test subject shall don the test enclosure. For the threshold screening test, he shall breathe through his open mouth with tongue extended.

E.    Using a DeVibiss Model 40 Inhalation Medication Nebulizer, the test conductor shall spray the threshold check solution into the enclosure. This nebulizer shall be clearly marked to distinguish it from the fit test solution nebulizer or equivalent.

F.    The threshold check solution consists of 0.83 grams of sodium saccharin, USP in water. It can be prepared by putting 1 cc of the test solution in 100cc of water.

G.    To produce the aerosol, the nebulizer bulb is firmly squeezed so that it collapses completely then released and allowed to fully expand.

H.    Ten squeezes are repeated rapidly and then the test subject is asked whether the saccharin can be tasted.

I.    If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked whether the saccharin is tasted.

J.    If the second response is negative ten more squeezes are repeated rapidly and the test subject is again asked whether the saccharin is tasted.

K.    The test conductor will take note of the number of squeezes required to solicit a taste response.

L.    If the saccharin is not tasted after 30 squeezes (Step 9), the test subject may not perform the saccharin fit test. An irritant fume test can be administered in this case.

M.    If a taste response is solicited, the test subject shall be asked to take note of the taste for reference in the fit test.

N.    Correct use of the nebulizer means that approximately 1 cc of liquid is used at a time in the nebulizer body.

O.    The nebulizer shall be thoroughly rinsed in water, shaken dry, and refilled at least each morning and afternoon or at least every four hours.

2.    Fit test:

A.    The fit test uses the same enclosure described previously.

B.    Each test subject shall wear his respirator for at least 10 minutes before starting the fit test.

C.    The test subject shall don the enclosure while wearing the respirator selected in section A above. This respirator shall be properly adjusted and equipped with a particular filter cartridge.

D.    The test subject may not eat, drink (except plain water), or chew gum for 15 minutes before the test.

E.    A second DeVibiss Model 40 Inhalation Medication Nebulizer is used to spray the fit test solution into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test solution nebulizer or equivalent.

F.    The fit test solution is prepared by adding 83 grams of sodium saccharin to 100 cc of warm water.

G.    As before, the test subject shall breathe through the open mouth with tongue extended.

H.    The nebulizer is inserted into the hole in the front of the enclosure and the fit test solution is sprayed into the enclosure using the same technique as for the taste threshold screening and the same number of squeezes required to solicit a taste response in the screening.

I.    After generation of the aerosol the test subject shall be instructed to perform the following exercises for one minute each.

i.    Normal breathing

ii.    Deep breathing. Be certain breaths are deep and regular.

iii.    Turning head from side-to-side. Be certain movement is complete. Alert the test subject not to bump the respirator on the shoulders. Have the test subject inhale when his head is at either side.

iv.    Nodding head up-and-down. Be certain motions are complete and made about every second. Alert the test subject not to bump the respirator on the chest. Have the test subject inhale when his head is in the fully up position.

v.    Talking. Talk aloud and slowly for several minutes. The following paragraph is called the “Rainbow Passage.” Reading it will result in a wide range of facial movements, and thus be useful to satisfy this requirement. Alternative passages which serve the same purpose may also be used.

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 no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow.”

J.    Every 30 seconds, the aerosol concentration shall be replenished using one-half the number of squeezes as initially used.

K.    The test subject shall so indicate to the test conductor if at any time during the fit test the taste of saccharin is detected.

L.    If the saccharin is detected the fit is deemed unsatisfactory and a different respirator shall be tried.

M.    Successful completion of the test protocol shall allow the use of the tested respirator in contaminated atmospheres up to 10 times the PEL. In other words this protocol may be used to assign protection factors no high than ten.

The above “Qualitative Fit Test Procedure” was taken from the EPA/NIOSH document entitled “A Guide to Respiratory Protection for the Asbestos Abatement Industry”, which is a frequently referenced document in the field of industrial hygiene. For high efficiency particulate (HEPA) respirator, the Saccharin fume method shall be used.

C-110.2 3M 9970 High efficiency respirator: Procedure for use of respirators

1.    Purpose:

To outline steps for the correct use and fit of respirator mask.

2.    Steps:

A.    Thread the top elastic strap through the top buckle. Repeat for the bottom elastic strap. Place the bottom elastic strap around the head, just below the ears. Untwist the strap.

B.    Pull the top strap over your head, resting it above the ears at the top back of your head. Untwist the strap.

C.    Adjust the strap tension by pulling the straps as shown.

D.    Strap tension may be decreased without removing respirator from the head by pushing out on the back of the buckle.

E.    Place your fingertips from both hands at the top of the metal nosepiece.

F.    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.

G.    The seal of the respirator on the face should be fit checked prior to wearing. To check the fit, cover the front of the respirator completely with both hands, being careful not to disturb the position of the respirator. Inhale sharply. A negative pressure should be felt inside the respirator. If any leakage is detected, readjust the position of the respirator and/or tension of the straps according to Steps #3, #4 and #5. Retest the seal. If you CANNOT achieve a proper fit, DO NOT enter the contaminated area. See your immediate supervisor.

3.    Key points:

Respirators cannot be used with beards or other facial hair that prevents direct contact between the face and the edge of the respirator.

C-110.3 Medical evaluation of respirator users

1.    When required:

Medical evaluation shall be done IF an employee’s Respiratory Questionnaire indicates medical conditions requiring a physicians approval to wear a respirator. The goal is to prevent harm to the respirator wearer because of the physiological or psychological stress imposed by the respirator.

The medical evaluation may be done at any time if the respirator wearer reports unusual, excessive, or undue discomfort or breathing difficulty while wearing a particular respirator. Before medical evaluation is done, however, the wearer’s supervisor shall attempt to solve the problem with additional training or provisions for an alternative respirator. If neither of these is feasible, the supervisor should request a medical evaluation for the wearer. The medical evaluation shall be done before an employee begins the use of a respirator and thereafter as outlined by the protocols for each air contaminate.

2.    Physician evaluation:

The medical evaluation shall be done by a physician who is familiar with respirators and the stresses imposed by their use. For each respirator that a respirator is used, appropriate testing will be determined.

3.    Records:

All written records related to medical evaluation shall be maintained in the employee’s medical record. The evaluating physician shall provide the supervisor with a statement confirming whether or not the employee is medically qualified to wear each respirator that may be assigned. Any limitations or conditions on the medical qualifications shall be included but shall not be confidential medical information.

4.    Responsibility for reporting respirator use problems:

Employees shall be responsible for reporting difficulties in respirator use to their supervisor. Supervisors shall be responsible for ensuring that difficulties in a respirator use are resolved in a safe manner and that all required medical evaluations are done. Occupational Health is responsible for ensuring that medical evaluations are properly done, that results are documented and communicated to supervisors, and that relevant medical records are maintained.

 

RESPIRATOR FIT TEST/TRAINING RECORD

EMPLOYEE: __________________________ EMPLOYEE #: ________ DATE: ________

EMPLOYEE JOB TITLE/DESCRIPTION: _______________________________________

EMPLOYER: _________________________________________________________________

LOCATION/ADDRESS: ________________________________________________________

RESPIRATOR SELECTED: ____________________________________________________

MANUFACTURER: ___________________________________________________________

NIOSH APPROVAL NUMBER: _________________________________________________

CONDITIONS WHICH COULD AFFECT RESPIRATOR FIT: (CHECK IF EXIST)

 

____ CLEAN SHAVEN

____ FACIAL SCAR

 

____ 1-2 DAY BEARD GROWTH

____ DENTURES ABSENT

 

____ 2+ DAY GROWTH

____ GLASSES

 

____ MOUSTACHE

____ NONE

COMMENTS: ________________________________________________________________

FIT CHECKS:

NEGATIVE PRESSURE: ____ PASS ____ FAIL ____ NOT DONE

 

POSITIVE PRESSURE: ____ PASS ____ FAIL ____ NOT DONE

FIT TESTING:

ABLE TO DETECT SACCHARIN TASTE: YES NO

 

NUMBER OF SQUEEZES REQUIRED TO REGISTER A TASTE

 

____ QUANTITATIVE

____ SACCHARIN FUME QUALITATIVE

 

____ PASS

____ PASS

COMMENTS: ________________________________________________________________

EMPLOYEE ACKNOWLEDGMENT OF TEST RESULTS:

EMPLOYEE SIGNATURE: _________________________________ DATE: ____________

TEST CONDUCTED BY: ___________________________________ DATE: ____________

RESPIRATORY QUESTIONNAIRE

Source: Washington Department of Labor and Industries

Industrial Hygiene Respirator Medical and Fit Test Record

Name: _____________________________ Emp. ID No: ___________ Date: ____________

Mailing Address: ______________________________________________________________

Age: ________ Sex: ___ Weight: ________ Changed since last fit? _____________________

Supervisor: ________________________________ Respirator Medical Date: ______________

Have you had or do you now have any of the following:

Disease/symptom

Yes

No

If “Yes,” explain

Lung disease

 

 

 

Heart trouble

 

 

 

Shortness of breath

 

 

 

Fainting or seizures

 

 

 

High blood pressure

 

 

 

Diabetes

 

 

 

Fear of tight or closed spaces

 

 

 

Heat exhaustion or heat stroke

 

 

 

Ruptured ear drum

 

 

 

Defective vision

 

 

 

Defective hearing

 

 

 

Contact lenses/glasses

 

 

 

Facial skin conditions (tumors, sores, eczema)

 

 

 

Facial paralysis (Bell’s palsy)

 

 

 

Are you taking medications?

 

 

 

Facial hair? ____ Yes ____ No

Special considerations (claustrophobia, eyeglasses, contacts, scars, wrinkles, extreme facial dimensions, broken or crooked nose etc.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Have you ever worn a respirator before? ____ Yes ____ No

If “Yes,” describe any apparent difficulties noted with respirator use:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________