OSHA first announced that the respiratory protection standard would be extended to the health services industry in a final rule published on Dec. 31, 2003. At the same time, OSHA withdrew the standard which had applied to health care facilities since 1998, "Respiratory protection for M. tuberculosis," 29 CFR 1910.139.
The respiratory protection standard was issued in January 1998, requiring an employer to provide respirators whenever "necessary to protect the health of the employee." The rule was not extended to the health care industry at that time, because in late 1997, OSHA had initiated a rulemaking proceeding to deal with occupational exposure to TB.
Although OSHA has described the affected establishments as "primarily hospitals," say Engel and Waters of law firm ReedSmith, the standard will affect any health services facility that treats patients with active TB where occupational exposure could occur, ranging from nursing homes to substance abuse treatment facilities.
According to Engel and Waters, the first new requirement imposed by the respiratory protection standard is updating the facility's respiratory protection program. Such an update should include:
- Procedures for selecting respirators in the workplace;
- Medical evaluations of employees required to use respirators;
- Fit-testing procedures for tight-fitting respirators;
- Training of employees in recognizing potential respiratory hazards and in respirator use; and
- Regular evaluation of effectiveness of program.
"The medical evaluation is an important new requirement, as the respiratory protection standard imposes a far more detailed evaluation than did the old standard," Engel and Waters point out. "1910.134 sets forth detailed procedures on the required medical evaluation, including a medical questionnaire, a written recommendation from a physician or other licensed health care professional that the employee is able to wear a respirator, as well as follow-up medical examinations under certain conditions."
They say the requirement that is expected to impose the greatest burden on health care facilities is the fit testing of respirators. Before an employee is required to use any respirator with a negative- or positive-pressure, tight-fitting facepiece, the employee must be fit tested with the same make, model, style and size of the respirator that will be used. Fit tests must be repeated every year. Moreover, additional fit tests must be conducted under many circumstances, such as any change in the employee's physical condition that could affect a respirator's fit, ranging from changes in body weight to dental conditions.
"The respiratory protection standard imposes other requirements, as well," say Engel and Waters, including training and recordkeeping provisions. "These requirements will be expensive, and may require many health care establishments to hire outside contractors such as industrial hygienists in order to comply," they note.