Panel 1 Elastomeric Respirators: User Perspective US Army Nurse Gas Mask Training 1942 Stocking over Surgical Mask, 2006 National Academy of Sciences Workshop on the Use of Elastomeric Respirators in Health Care May 22, 2018, Washington, DC Mark Catlin Occupational Health and Safety Director Service Employees International Union (SEIU) Washington, D.C.
Service Employees International Union (SEIU) SEIU represents one million health workers at more than 1,000 hospitals, long-term care facilities and home care agencies, including: 40,000 physicians 80,000 nurses 280,000 other hospital workers 200,000 long-term care workers 400,000 home care workers SEIU First Receiver training in Niagara Falls
High Level of Interest in Elastomeric Respirators from SEIU and other Union Nurses As an option in place of N95 FF, but not PAPRs For routine use, not just for during a pandemic Plan to conduct elastomeric respirator awareness training for SEIU and other union nurse leaders beginning fall 2018
Strengths and Limitations of Elastomeric Respirator Use? Elastomeric Filtering Facepiece Respirator Fit Fit testing User Seal Check Assigned Protection Factor Employer compliance with OSHA requirements necessary Reliable can use all OSHA approved methods & test agents User can be reliably trained to do & user can readily perform during work Currently poor compliance by many healthcare employers Reliable? Difficult for user to perform reliably 10 10 * *previously 5 Filter N95, but more protective P100 readily available N95
Strengths and Limitations of Elastomeric Respirator Use? Elastomeric Filtering Facepiece Respirator Use Care and inspection Donning and Doffing Employer compliance with OSHA requirements necessary Currently poor compliance by many healthcare employers Currently many employers have users reuse filtering facepiece for one or more shifts
Strengths and Limitations of Elastomeric Respirator Use? Elastomeric Filtering Facepiece Cleaning and Disinfecting Proper Doffing re: infection control Proper cleaning and disinfecting Employer compliance with OSHA requirements necessary or by centralized system Currently poor compliance by many healthcare employers N/A Workers often prefer their own respirator that they care for and they know will be available Workers often report FF not available in model / size needed
Strengths and Limitations of Elastomeric Respirator Use? Elastomeric Filtering Facepiece Training Inspection and use Proper donning and doffing Employer compliance with OSHA requirements necessary Currently poor compliance by many healthcare employers Proper cleaning and disinfecting ---- Hands-on training and practice Critical Critical
Concerns of SEIU Members with Elastomeric Respirators How and when to disinfect? Where to store so available as needed? How might use interfere with patient communication Most are glad to hear of another choice of respirator
What Are the Lessons We Can Learn from Healthcare Expereince? Elastomeric Respirators currently used successfully at: University of Maryland Hospital System of 14 Affiliate Hospitals, 2,587 Licensed Beds, 28,000 employees The Texas Center for Infectious Disease (TCID), 75-bed specialty hospital in San Antonio, currently the only freestanding inpatient TB treatment facility in the United States. Operated by the State of Texas and affiliated with The University of Texas Health Science Center at Tyler and its Heartland National TB Center, and the University of Texas Health Science Center at San Antonio.
Experience of SEIU Members with Respirators at Healthcare Facilities Challenges : Infrequent use weekly, monthly, annually (periodic refresher training needed) PAPR batteries not charged / parts missing or needed replacing Uncomfortable / awkward to wear * Interfered with patient communication / care / limits movement * No reports of patient upset / concern from respirator use * Healthcare workers reported these as minor problems in which they learned to work around
Experience of SEIU Members with Respirator Use at Healthcare Facilities What actions need to be taken to ensure respirators are properly used in the health care setting? Clear employer policy on the need for and use of respirators (when and how) Supervisor support for policy / respirator knowledge Healthcare worker training, in advance of use with hands-on practice donning, doffing and working in Periodic program review, refresher training.
Occupational Health and Infectious Disease History, 1990s First NIOSH Recommended Guidelines for Personal Respiratory Protection of Workers in Health-Care facilities Potentially Exposed to Tuberculosis (PAPRs and Supplied-air Respirators) NIOSH approves disposable particulate respirator (N95) use at Health-Care facilities for Tuberculosis 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 OSHA issues Bloodborne Pathogens standard Healthcare Unions petitioned OSHA in 1986 for standard Coalition to Fight TB in the Workplace (14 Unions) petitions OSHA for standard. OSHA initiates TB rulemaking in January 1994 OSHA issues proposed rule on Occupational Exposure to Tuberculosis for public comments and hearings OSHA exempts TB from updated respiratory protection standard
Occupational Health and Infectious Disease History, 2000s SARS outbreak in Asia & Canada Droplet vs Airborne dispute Respirator vs mask dispute H1N1 outbreak Droplet vs Airborne dispute Respirator vs mask dispute Fit testing dispute Cal/OSHA ATD standard passed 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 OSHA withdraws Tb rulemaking. Healthcare employers must now follow 1998 respirator standard 2004-2008 Wicker rider prohibits OSHA enforcement of annual fit-testing of respirators for Tb. Supported by AHA and APIC During entire H1N1 outbreak OSHA/CDC require employers use respirators, not masks. OSHA request for information on occupational exposure to infectious agents in healthcare settings
Occupational Health and Infectious Disease History, 2010s & Beyond Whooping Cough outbreaks Measles outbreaks MERS concerns Contact diseases concerns (MRSA, VRE, others) Ebola outbreak Enforceable worker protections (scope beyond healthcare) Site-specific detail plan Precautionary removal 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020? OSHA requests information on occupational exposure to infectious agents in healthcare settings OSHA holds informal stakeholder meetings concerning occupational exposure to infectious diseases. OSHA convened Small Business Advocacy Review Panel (SBAR Panel) OSHA to issue proposed infectious disease standard for public comment and hearings (January 2017)?
Look Forward to Continuing this Discussion Mark Catlin Occupational Health and Safety Director SEIU 1800 Massachusetts Avenue Washington, DC 20036 (202) 436-0856 mark.catlin@seiu.org