Welcome to respiratory protection training for healthcare workers. This training is for all employees who are required to use respirators.

If you work around hazardous substances, there could be danger in the air. You may not see it or smell it, but fumes, vapor, gas, or certain dusts in the air you breathe on the job could be hazardous to your health. In some cases, biological agents such as bacteria in the air could also be harmful.

That’s why sometimes you might need respiratory protection—in other words, wearing a respirator—to keep you from getting sick.

Respirators are not for casual use, however. You have to know how to choose the right kind of respirator, go through testing to make sure it fits properly, and inspect and maintain it correctly.

Session Objectives

The main objective of this session is to tell you about respiratory hazards in the workplace and to talk about the respiratory protection you might need at times to protect your health. By the time the session is over, you should be able to:

• Recognize respiratory hazards in your job;
• Identify and use appropriate respiratory protection;
• Get a good, safe fit when using a respirator; and
• Inspect, maintain, and store respirators properly.

What You Need to Know

During this session, we will discuss:

• The facility’s respiratory protection program;
• OSHA requirements for respiratory protection in the workplace;
• Respiratory hazards;
• Capabilities and limitations of respirators; and
• Respirator selection, fit, inspection, cleaning, and storage.

When Do You Need To Wear a Respirator?

The first question you need to ask about respiratory protection is, when do you need to wear a respirator?

• OSHA requires us to identify respiratory hazards in the facility and provide employees with respirators when a hazardous substance’s airborne levels are higher than its Permissible Exposure Limit. Permissible Exposure Limits, or PELs, are listed in the safety data sheet, or SDS (formerly known as the material safety data sheet, or MSDS) for each hazardous substance in the facility. Generally, ventilation is sufficient to keep levels of airborne contaminants safe. But when it’s not, respirators may be required.
• You might also be required to wear a respirator if you work with or around patients who have tuberculosis, or TB, and other, infectious respiratory diseases such as SARS-coronavirus or avian influenza. These diseases spread bacteria through the air when an infected person coughs, sneezes, or even speaks.
• Respirators are also required during some emergency response operations, such as cleanups of hazardous chemical spills.

Circumstances in which respirators are required are identified in the facility’s respiratory protection program, which we’ll review next.

The Facility’s Respiratory Protection Program

• Our facility is required by OSHA to have a written respiratory protection program that describes the procedures for:

– Respirator selection, use, training, and fitting;

– Respirator maintenance, storage, and inspection; and

– Work area surveillance;

• The plan must also describe the process for medical examinations related to respirator use; and
• It must describe procedures for evaluating the effectiveness of the respiratory protection program.

Are you familiar with our facility’s respiratory protection program? If you may need to wear a respirator because of hazardous substances or airborne contaminants involved in your work, it’s important for you to understand the basic requirements of our respiratory protection program.

Respiratory Hazards

As we said, high airborne levels of hazardous substances that can’t be controlled by ventilation could be hazardous to your health. For example, you might be exposed to hazardous levels of airborne contaminants if you:

• Work with hazardous substances that can release hazardous vapors, gas, fumes, dust, or fibers—including substances such as pesticides, asbestos, waste anesthetic gases, ethylene oxide, and formaldehyde;
• Clean up spills of hazardous substances;
• Work with or around TB, SARS-coronavirus or avian influenza patients;
• Perform some laboratory procedures involving hazardous substances; or
• Assist in surgical procedures that create laser plumes.

Think about the jobs you perform and the hazardous substances you work with. Which of those might require respiratory protection?

Respiratory Hazards (cont.)

Inhaling hazardous substances in the air can make you sick. Some substances can cause:

• Lung and tissue damage or irritation;
• Respiratory diseases;
• Cancer or other serious illness;
• And even death, if concentrations of the contaminant are high enough.

Respiratory Hazards (cont.)

Here are two other important points about respiratory hazards:

• Don’t depend on smell or vision to identify hazardous substances in the air. They may have no odor and be invisible. You could be seriously affected before you know there’s a contaminant present in the air.
• Also, don’t rely on surgical masks or dust masks to protect you from most respiratory hazards. Surgical masks only help protect against some germs. They are ineffective against many hazardous substances, including TB bacteria. Dust masks only prevent inhalation of large dust particles, like saw dust. They do not provide sufficient protection against hazardous vapor, gas, or fine dust particles.

Do you know when wearing a surgical mask or dust mask provides sufficient protection and when it is not enough to protect your health?

Respiratory Protection Hazards and Requirements

Now it’s time to ask yourself if you understand the information that has been presented so far.

• Do you understand what we’ve discussed about our respiratory protection program and OSHA requirements?
• Do you understand the information about respiratory hazards and about when respiratory protection may be required?

It’s important for your safety that you understand all this information.

Now let’s go on and talk about types of respirators and how to select the right one for the respiratory hazards you face on the job.

Two Basic Types of Respirators

There are two basic types of respirators. Air-purifying respirators are the most common. If you need to use a respirator on the job, in most cases, it will be an air-purifying respirator. These respirators are used when there is enough oxygen in the air to breathe normally, but there are hazardous contaminants that need to be filtered out.

• Air-purifying respirators use replaceable canisters or cartridges to filter out hazardous impurities in the air. Canisters and cartridges are color-coded so you won’t pick the wrong one.
• Sometimes, there isn’t enough oxygen in the air to breathe normally. Other times, cartridges can’t safely filter out all the hazardous substances in the air. In these circumstances, you need the second type of respirator—the atmosphere-supplying respirator. Atmosphere-supplying respirators may have a face mask connected by a hose to a stationary air supply, or they may be a self-contained breathing apparatus with a portable air supply, such as in scuba diving tanks.

Are you familiar with the respirators that we use in the facility?

Selecting the Right Respirator

How do you know which respirator to select?

• It depends on the hazards you face—the type and level of contaminants in the air and/or the amount of oxygen.
• The SDS for hazardous chemicals generally specifies the type of respirator that will protect you from exposure.
• But basically, you don’t need to be overly concerned with respirator selection. We’ll do that for you. You will be supplied with the right type of respirator for the hazards you face. The main thing you will need to be concerned about is using your assigned respirator when you’ve been told to use it, and making sure that if it’s an airpurifying respirator, it’s equipped with the right color-coded canister or cartridge.

Do you know which color canisters or cartridges are designed to protect you from which hazards? If you’re not sure, check with your supervisor.

Getting the Right Fit

A respirator must fit well or it won’t work. Even a tiny gap between the respirator and your face could let in the contaminated air the respirator is designed to keep out. An uncomfortable respirator is hard to wear for long periods.

When fitting a respirator, always check to make sure that it:

• Fits securely but not too tightly around your chin;
• Doesn’t pinch your nose;
• Doesn’t slip; and
• Leaves room for you to move your head and talk.

Getting the Right Fit (cont.)

You’ll get a special fit test when you’re issued an air-purifying respirator. There are two types of tests that will be performed—a qualitative test and a quantitative test.

In both, a test agent—a harmless vapor, smoke, gas, or aerosol—is put into a small enclosure where you are wearing a respirator. You will do exercises to simulate work movements.

• In a qualitative test, you know if you have a good fit if you cannot sense the test agent.
• A quantitative test uses special instruments to detect respirator leaks.
• Retesting is required annually and after weight loss or dental work, either of which can change the contours of your face and affect the fit of a respirator.

Remember, getting the right fit is essential, so it’s important for you to cooperate with the testing process and make sure you get a good, safe fit.

Seal-Checking Your Respirator

In addition to an initial fit test, you have to seal-check your respirator every time you use it to make sure there are no leaks. There are two types of seal checks—the positive pressure test and the negative pressure test. You’ll be told which test to use.

• To conduct a positive pressure test:

– Close off the exhalation valve.

– Exhale gently into the face piece.

– The face piece should bulge a little, but if no air leaks out, you have a good fit.

• To conduct a negative pressure test:

– Put your hands over the inlet opening of the cartridges or canister.

– Inhale gently so face piece collapses slightly.

– Hold your breath for 10 seconds.

– If the face piece remains in slightly collapsed condition, with no air leaking in, you have a good fit. Do you know how to perform these tests? Ask your supervisor to show you again if you’re not sure.

Other Factors That Affect Fit

Other factors may also affect fit:

• You may not be able to wear a respirator if you have a beard. Respirators with tight-fitting face pieces cannot be worn if you have facial hair that comes between the sealing surface of the face piece and the face, or that interferes with valve function.
• Some large eyeglass frames may not fit comfortably under the respirator face piece. If you need to use a respirator on the job, you may need to use different frames.
• Some people may not be able to use a respirator at all. Their facial features just don’t allow for a safe fit with a respirator. For example, a particularly large nose or chin, sunken cheeks, or missing teeth may make it impossible to properly fit a respirator.

Not Everybody Can Wear a Respirator

Before you can wear a respirator you have to have a medical checkup to see if it’s safe for you to use one. In general, you can’t wear a respirator if you have:

• Breathing problems, such as asthma;
• A heart condition;
• Claustrophobia; or
• Heat sensitivity.

Inspect Respirators Before Each Use

Now let’s talk about another important respirator safety topic— inspecting your respirator. Before each use, you must check to make sure that there are no:

• Holes in the filters;
• Cracks in the face shield;
• Deterioration in rubber straps, hoses, nose clips, and so on;
• Dents or corrosion in filters, cartridges, and canisters; or
• Loose connections.

Any of these things—or any other defects—can let hazardous air into the respirator and make you sick.

If you find a problem, report it to your supervisor. Never use a defective respirator.

For atmosphere-supplying respirators, of course, you also need to make sure that air tanks are fully charged before use and that regulators are working properly.

Think about what you have to do when you inspect a respirator.

Clean Respirators After Each Use

You also have to keep respirators clean so that they stay in good condition and work properly. That means cleaning after each use. For air-purifying respirators, follow these basic cleaning procedures:

• Remove filters, cartridges, or canisters. Disassemble face pieces by removing speaking diaphragms, demand and pressure-demand valve assemblies, hoses, or any components recommended by the manufacturer. Discard or repair any defective parts.
• Wash components in warm water with a mild detergent or with a cleaner recommended by the manufacturer. A stiff bristle—but not wire—brush may be used to facilitate the removal of dirt. Rinse components thoroughly in clean, warm, running water—no hotter than 110 degrees Fahrenheit. Drain. Remove the cartridges.
• Be careful when replacing any inhalation and exhalation valves.

Clean Respirators After Each Use (cont.)

• Dry with a clean, dust-free cloth or air dry in a clean room.
• Reassemble the respirator components, and test to make sure it is fully functional for use.
• As far as dust masks are concerned, they should be thrown away after each use. Once a dust mask is coated with dust, replace it. Don’t try to clean it.

Do you understand what you need to do to keep your respirator clean? If you have any questions, ask your supervisor. Maintaining respirators properly is important. Poor maintenance can lead to poor performance, and that means you won’t be adequately protected.

Store Respirators Properly

In addition to cleaning, proper maintenance of respirators also includes proper storage.

• Protect all respirators and other protective equipment from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals when they are stored.
• Store the respirator and dry cartridges in a clean container or bag.
• Do not allow the respirator to be stored in a way that will allow the face piece to become distorted.

Do you understand storage requirements? If you have any questions, ask your supervisor.

Safe Use of Respirators

• Now take a moment and think about the information about respirator use that has been covered in the previous slides. Do you understand:

– How to select the right respirator for the job?

– How to get a good, safe fit?

– How to inspect respirators to make sure they are safe to use?

– How to clean and store respirators to keep them in good condition?

It’s important that you understand all this information. Any gaps in your knowledge about safe use of respirators could put you at risk.

Now let’s conclude the session by reviewing the key points covered during the session.

Key Points to Remember

Here are the main points to remember from this session on respiratory protection:

• Understand the hazards of dangerous airborne substances in your work area and in the tasks you perform.
• Always choose the right respirator for the hazards you face.
• Know how to properly fit, use, inspect, clean, and store respirators.
• Inspect respirators before each use.
• And finally, report any problems with respirators immediately— never use a defective respirator.

This concludes the Respiratory Protection for Healthcare Workers training session.