Respiratory Protection in Occupational Medicine

Introduction to Respiratory Protection

• The European Respiratory Society recommends that elimination or minimization of exposure at the source or in the environment is considerably more effective than providing personal protective equipment to the worker 1, 2.
• Respirators should be used as a provisional measure while source controls are being implemented, or when these controls are not possible 1, 2, 3.

Effectiveness of Respiratory Protection

• The American Thoracic Society notes that respiratory protective equipment reduces acute respiratory symptoms significantly but does not eliminate them completely, even with proper use 4, 5.
• Studies have demonstrated that respirators provide a 93-96% reduction in exposure to wheat allergens, but fail to provide complete protection 2, 4.

Program Requirements for Respiratory Protection

• The International Commission on Occupational Health states that all use of respirators must be administered as part of a comprehensive Respiratory Protection Program (RPP) that includes selection, training, fit testing, maintenance, and medical monitoring 7, 8, 9.
• Programs must include provisions for user training, equipment selection and sizing, maintenance, and performance of initial and annual fit tests 7, 8.

Technical Specifications for Respiratory Protection

• The National Institute for Occupational Safety and Health (NIOSH) recommends that a NIOSH-certified N95 respirator (or international equivalent) is the minimum level of respiratory protection required, with a filtration efficiency of 95% for 0.3-micron particles 7, 8, 10.
• P-100 or PAPR respirators with HEPA filters provide a filtration efficiency of 99.97%, making them more than 100 times more effective than N95 respirators 9.

Medical Evaluation and Physiological Risks

• The European Respiratory Society recommends that workers undergo medical evaluation to determine if they can safely use respirators, especially those with pre-existing respiratory or cardiac conditions 9.
• Working with complete respiratory protective equipment presents physiological risks, including dehydration and heat stress, requiring rigorous attention to limiting work shifts 7, 8, 10, 11.

Training and Fit Testing

• The International Commission on Occupational Health states that individuals and groups of workers must be trained in the use of equipment, including how to safely put on and remove respiratory protective equipment 7, 10.
• The program must include training on correct use, limitations, and maintenance of respirators 9.

Ineffectiveness in Established Occupational Asthma

• The European Respiratory Society notes that in workers with established occupational asthma, respiratory protective equipment results in improvement but not complete suppression of respiratory symptoms and airway obstruction in the short term 5.

Maintenance and Storage

• The International Commission on Occupational Health recommends that N95 respirators cannot be stored in plastic bags unless the plastic is non-electrostatic, as this will inactivate the electret and the respirator will cease to function 8.
• All respirators must be stored in paper bags or cardboard boxes when not in use 8.