This blog post covers OSHA guidance for handling the respirator shortage. Here’s what you will learn by reading:
- OSHA’s enforcement discretion of the respiratory standard during the COVID-19 pandemic
- Respirator shortage guidance from OSHA
- Extended use of respirators
- Reuse of respirators
- Use of expired respirators
- Use of respirators not approved by NIOSH
- Why surgical masks and face shields can’t replace respirators
- What to do if you can only find respirators with exhalation valves
Global Shortage of Respirators
Due to COVID-19, more employees than ever wear respirators. It doesn’t help that everyday citizen also purchase respirators. Ever since the beginning of the COVID-19 pandemic, there has been a shortage of respirators.
The President directed the Secretary of Labor to “consider all appropriate and necessary steps to increase the availability of respirators.”
How will OSHA exercise enforcement discretion?
The Occupational Safety and Health Administration (OSHA) enforces the respiratory protection standard. This blog post outlines OSHA’s guidance for respiratory protection throughout the pandemic. But although OSHA is allowing some flexibility, your practice could still be fined.
Here’s what OSHA will consider if your practice is noncompliant. They will look at if the employer:
- Made a good faith effort to obtain other alternative filtering facepiece respirators, reusable elastomeric respirators, or powered air-purifying respirators (PAPRs) appropriate to protect workers against COVID-19
- Monitored their supply of N95s and prioritized their use following the CDC’s guidance
- Used surgical masks or face shields as interim protection (surgical masks aren’t respirators and don’t provide protection during aerosol-generating procedures)
- Implemented other measures, such as engineering controls, work practices, or administrative controls, that reduce the need for respiratory protection
What is the respirator shortage guidance from OSHA?
Next, we will be looking at OSHA’s guidance for the shortage of N95 respirators.
First, make sure you maintain your practice’s written Respiratory Protection Program (RPP). And if you don’t have one yet, creating one needs to be your first priority. If you need guidance on your written RPP, check out this webinar by Smart Training’s Vice President of Healthcare, Lee Slaton.
Next, implement other controls to make up for the lack of respirators. Try to limit the need for respirators. Respirators are personal protective equipment (PPE), which is the least effective form of protection. Here is OSHA’s hierarchy of controls, in order from most effective to least effective:
- Elimination: physically remove the hazard
- Substitution: replace the hazard
- Engineering controls: isolate people from the hazard
- Administrative controls: change the way people work
- PPE: protect the worker with PPE
OSHA: Employees can extend the use of or reuse respirators
OSHA writes that due to the pandemic, “the same worker is permitted to extend use of or reuse the respirator, as long as the respirator maintains its structural and functional integrity and the filter material is not physically damaged, soiled, or contaminated.”
OSHA writes that employers must “address in their written RPPs the circumstances under which a disposable respirator will be considered contaminated and not available for extended use or reuse.”
Extended use or reuse: which is better?
According to OSHA, extended use should be prioritized over reuse. This is because there is a contact transmission risk that comes with donning and doffing a respirator during reuse. Similarly, the CDC writes, “Extended use is favored over reuse because it is expected to involve less touching of the respirator and therefore less risk of contact transmission.”
Extended use should also be used instead of reuse when employees are performing aerosol-generating procedures.
What is extended use of respirators?
Extended use is when an employee wears the same respirator with different patients. The CDC writes, “Extended use has been recommended as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.”
Usually, employees should remove their respirator after being in contact with a patient that is COVID-19 positive. But with extended use, the employee would keep the respirator on to treat another patient. However, according to the CDC, extended use is best suited when an employee is treating multiple patients with COVID-19 back-to-back.
Wearing the respirator in the presence of a COVID-19 patient means the respirator is potentially infectious. Employees should change their respirators when going to treat a patient that isn’t COVID-19 positive.
What is reuse of respirators?
Reuse is when an employee uses the same respirator for different patients, but instead of keeping it on, the employee takes it off and doffs it between patients. The respirator is stored between the patients. But the respirator should be clearly labeled so the same employee wears the respirator again.
OSHA writes, “When respirators are being reused, employers should pay particular attention to workers’ proper storage of the filtering facepiece respirators (FFRs) in between periods of reuse.”
Here is some guidance from OSHA on reusing respirators:
- Employees need to perform a user seal check every time they put on (don) a respirator
- If a respirator can’t pass the user seal check, employees can’t use that respirator
- Employers need to train workers to help them understand when a respirator should be discarded
- Employees need to don/doff respirators correctly to reuse them safely
- Employers need to train workers in how to don/doff respirators
What if my only option is expired respirators?
First, in order to use expired respirators, employers need to have demonstrated good faith efforts to use alternative solutions to protect employees. Good faith efforts were outlined in the beginning of this post when we covered how OSHA will exercise enforcement discretion.
So you demonstrated good faith efforts already, but all you could get your hands on is expired respirators. Here are OSHA’s rules relating to expired respirators. Employers should:
- Only use previously NIOSH-certified expired N95 filtering facepiece respirators (FFRs)
- Notify workers that they are using expired N95s
- Not co-mingle products that are past expired with items that are within their shelf life
- Visually inspect, or train and ensure that workers visually inspect, the N95 FFRs to determine if the structural and functional integrity of the respirator has been compromised
- Seek assistance from the respirator manufacturer or independent lab regarding testing of those stored respirators prior to use
Note: extended use and reuse are preferred over using expired respirators.
What if I can’t find NIOSH-approved respirators?
N95 respirators are in high demand, since they are primarily what dental offices use. But you can legally use KN95 respirators during the COVID-19 pandemic and still remain OSHA compliant.
As recently as October 15, 2020, the U.S. Food & Drug Administration (FDA) reissued the Emergency Use Authorization (EUA). This EUA allows healthcare practices to purchase KN95 respirators. KN95 respirators are similar to N95 respirators, but they are manufactured in China.
Under normal circumstances, respirators must be approved by the National Institute for Occupational Safety and Health (NIOSH). NIOSH-certified respirators are one of the mandatory aspects of the OSHA’s Respiratory Protection Program. KN95 respirators are not NIOSH-certified, but they are accepted due to the FDA’s EUA. For a list of respirators that are not NIOSH-approved, but the FDA is allowing under the EUA, check out the FDA’s Appendix A.
However, the Center for Disease Controls (CDC) writes, “As N95 respirator availability returns to normal, healthcare facilities should promptly resume conventional practices.” Similarly, although the FDA says using respirators not approved by NIOSH is okay, OSHA says to try your best to provide NIOSH-approved respirators. They don’t have to be N95 respirators. Here’s a list of NIOSH-approved respirators.
This EUA also allows healthcare practices to use NIOSH-approved respirators that are expired. But neither the FDA nor OSHA is allowing respirators that aren’t NIOSH-approved to be used past their expiration dates.
Can surgical masks or face shields replace respirators?
No, surgical masks cannot replace respirators. Respirators filter the air the user breathes in, while surgical masks don’t. Surgical masks can protect the wearer from splashes and sprays, but not the aerosols that spread COVID-19.
Similarly, face shields are not respirators, and can’t replace respirators.
What about a respirator with exhalation valves?
Some respirators have exhalation valves. Although they will still protect the wearer, they won’t protect the wearer from spreading it to others. So here’s the CDC’s guidance:
- Wear a respirator without an exhalation valve when both source control and respiratory protection are required
- If only a respirator with an exhalation valve is available and source control is needed, cover the exhalation valve with a surgical mask, procedure mask, or a cloth face covering that does not interfere with the respirator fit
However, Lee Slaton suggests not wearing respirators with exhalation valves in his webinar.
Are your employees using respirators?
If any of your employees are using respirators, your practice needs an OSHA Respiratory Protection Program. Smart Training’s Platinum+ Dental Solution, Dental Essentials, and Complete Medical Compliance feature this OSHA Written Program.
The initial set up time for your respiratory protection program is about 15-20 minutes. Check out our blog to learn more about setting up your program on our learning software. Our software makes creating your respiratory protection program painless and simple.
Request a demo here if you have none of the above plans and still want respiratory protection.
Reaching OSHA compliance has never been easier than with Smart Training.