OSHA Respiratory Protection Program & Mask Fittings

Regulation | July 07, 2020 | by Cory Kallheim

There have been some state agencies investigating and/or reminding providers of the CDC recommendation and the OSHA requirement of a respiratory protection plan in nursing communities pursuant to 29 CFR § 1910.134.

There have been some state agencies investigating and/or reminding providers of the CDC recommendation and the OSHA requirement of a respiratory protection plan in nursing communities pursuant to 29 CFR § 1910.134. This issue involves the fitting of N95 masks and training protocols around respiratory protection. Pursuant to the language of the OSHA regulation, it should also include a medical evaluation of each employee on whether they are medically appropriate to wear such a mask. The purpose of this regulation is to protect employees from occupational diseases by breathing air contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, sprays, or vapors.

The only CMS memo on respirators and facemasks was issued March 10th. CMS acknowledged that PPE was in short supply, including respirators, and allows the use of facemasks on a temporary basis and directs surveyors to not validate the latest fit test by providers.

OSHA has issued compliance and enforcement guidance recognizing that there is a shortage of PPE and masks and giving investigators discretion in enforcing these provisions. According to the April 3, 2020 guidance, OSHA reiterated that:

OSHA will, on a case-by-case basis, exercise enforcement discretion when considering issuing citations under 29 CFR § 1910.134(d) and/or the equivalent respiratory protection provisions of other health standards in cases where:

  • The employer has made a good faith effort to obtain other alternative filtering facepiece respirators, reusable elastomeric respirators, or PAPRs appropriate to protect workers;
  • The employer has monitored their supply of N95s and prioritized their use according to CDC guidance (www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html; www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html);
  • Surgical masks and eye protection (e.g., face shields, goggles) were provided as an interim measure to protect against splashes and large droplets (note: surgical masks are not respirators and do not provide protection against aerosol-generating procedures); and
  • Other feasible measures, such as using partitions, restricting access, cohorting patients (healthcare), or using other engineering controls, work practices, or administrative controls that reduce the need for respiratory protection, were implemented to protect employees.

We will continue to monitor and let us know if your states are communicating on this issue and/or starting to enforce the OSHA protocol. The clear focus at this time is for fitting N95 masks and not on the medical evaluation piece as that seems impractical at this time.

Here are the relevant resources on this topic:

OSHA Regulation: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134

OSHA Guidance March 14, 2020: https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit

OSHA Guidance April 3, 2020: https://www.osha.gov/memos/2020-04-03/enforcement-guidance-respiratory-protection-and-n95-shortage-due-coronavirus

OSHA Guidance April 8, 2020: https://www.osha.gov/memos/2020-04-08/expanded-temporary-enforcement-guidance-respiratory-protection-fit-testing-n95

CMS Memo QSO 20-17-ALL: https://www.cms.gov/files/document/qso-20-17-all.pdf

CDC/NIOSH Hospital Respiratory Protection Program Toolkit: https://www.cdc.gov/niosh/docs/2015-117/pdfs/2015-117.pdf?id=10.26616/NIOSHPUB2015117