Respiratory Protection Program

Essential Elements of the Program

The Centers for Disease Control and Prevention recommends that a comprehensive respiratory protection program include assignment of responsibilities, written standard operating procedures, medical evaluation, training, fit testing, and proper maintenance of equipment 1, 2, 3
The program should have a clearly identified administrator to coordinate all components, and the administrator should have experience in relevant topics, including infectious diseases and occupational health 1, 2, 3
All aspects of the respiratory protection program should be documented in writing, including procedures for storage, reuse, and disposal of respirators 1, 2, 3
The program should include protocols for specific procedures, such as handling and maintenance of respirators, and should be developed in consultation with the infection control team 2, 3, 6

Workers should not be assigned to tasks that require respirators unless they are physically able to perform the work while using the equipment, according to the Centers for Disease Control and Prevention 3, 7, 8
Medical screening should be performed at the time of hiring and then periodically, such as every 5 years, to assess the worker's ability to use a respirator safely 3, 7, 8
The screening process should begin with a general questionnaire to identify any medical conditions that may affect the worker's ability to use a respirator 3, 7, 8
Routine physical examinations, chest radiographs, or spirometry are not required for workers who use respirators, as recommended by the Centers for Disease Control and Prevention 3, 7

Workers who use respirators and their supervisors should be informed about the need to use respirators and the potential risks of not using them, as required by the Occupational Safety and Health Administration 8, 4
Training should include information on the nature, extent, and effects of respiratory hazards, as well as the proper use, limitations, and maintenance of respirators 8, 4
Workers should be trained on how to properly put on and take off respirators, and how to use them safely and effectively 4

The program should include provisions for initial and annual fit testing to ensure that the respirator fits properly and provides adequate protection 4
Fit testing is essential to ensure that the respirator seals adequately on the user's face, as recommended by the Occupational Safety and Health Administration 4

Respirators should be properly maintained and stored to ensure their effectiveness, including regular inspection, cleaning, and maintenance according to the manufacturer's instructions 1, 2, 6
Before each use, the exterior of the filter material should be inspected for damage or dirt, and the filter should be replaced or the respirator discarded if necessary 2, 3, 6
Respirators should be stored in paper bags or cardboard boxes when not in use, and should not be stored in plastic bags unless the plastic is non-static, as recommended by the Centers for Disease Control and Prevention 4

The Occupational Safety and Health Administration requires that a comprehensive respiratory protection program be developed, implemented, administered, and periodically reevaluated in healthcare settings 1, 2, 7, 5
All healthcare workers who need to use respirators should be included in the respiratory protection program, as required by the Occupational Safety and Health Administration 1, 2, 7

A NIOSH-certified N95 respirator (or equivalent international standard) is the minimum level of respiratory protection required, with a filtration efficiency of 95% for particles of 0.3 microns 4
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 4

Respirators should be used as an interim measure while source controls are being implemented, or when source controls are not possible, as recommended by the Centers for Disease Control and Prevention 4
Elimination or minimization of exposure at the source or in the environment is considerably more effective than providing personal protective equipment to the worker, according to the Occupational Safety and Health Administration 4
Working with complete respiratory protective equipment presents physiological risks, including dehydration and heat stress, requiring rigorous attention to limit work shifts 4