On Saturday, March 15, 2020, Acting Director Patrick Kapust of OSHA’s Directorate of Enforcement Programs issued a public memorandum detailing temporary enforcement guidance for the healthcare industry. The memorandum was directed to healthcare providers who, in the course of their duties, are required to care for suspected or known victims of the 2019 novel coronavirus disease (COVID-19). The change in enforcement is the allowance of enforcement discretion regarding the requirements for ongoing annual fit testing as described in 29 CFR § 1910.134(f)(2).

In light of the recent shortages of respiratory protection traditionally used in healthcare applications for airborne and droplet isolation patients, the following practices are recommended as viable options:

• Use of respirators of higher rating than those designed for healthcare application.

  • These may include N99, N100, Powered Air Purifying Respirators (PAPR), reusable elastomeric respirators with appropriate filters, and others.

• Use of non-destructive fit-testing such as qualitative methods instead of quantitative.

  • Both methodologies provide effective fit determination.

The OSHA memorandum references the following additional respirator conservation recommendations provided by the CDC for crisis situations:

• Use of respirators beyond the manufacturer-recommended shelf life.

  • It is important to ensure that employees perform user seal checks and detailed inspection of tension bands and nose bridge components when using respirators beyond the recommended shelf life.

• Use of respirators certified in other countries that are similar to the N95.

  • The following table lists several examples:

• Selective use of respirators based upon tasks being performed. 

  • Healthcare providers may elect to use face masks (source control devices) instead of respirators under the following conditions:

    • When performing patient care at a distance of 3 feet or greater.

    • When performing patient care at a distance of 3 feet or less when the patient is also wearing a face mask.

  • When performing patient care at a distance less than 3 feet when the patient is not wearing a face mask or when performing procedures which generate aerosols, respirators must be worn.

• Designation of convalescent personnel.

  • When no respirators are available, convalescent healthcare providers (those recovering from COVID-19 themselves) may be designated for COVID-19 patient care. These employees may have developed some protective immunity, though this has not yet been confirmed.

• Exclude personnel of higher risk from contact with known or suspected COVID-19 patients.

  • Personnel of advanced age or those taking immune compromising medication, among other risk-elevating conditions, should be kept isolated from contact with suspected or known COVID-19 patients.

OSHA enforcement discretion based on employers following other requirements of 29 CFR § 1910.134.

The OSHA memorandum has made clear that “OSHA field offices shall exercise enforcement discretion concerning the annual fit testing requirement, 29 CFR § 1910.134(f)(2), as long as employers [follow other requirements of 29 CFR § 1910.134].”

Some of these requirements include:

• Making a good-faith effort to comply with 29 CFR § 1910.134.

• Implementing CDC and OSHA strategies for optimizing the supply of N95 filtering facepiece respirators.

• Performing initial fit testing in accordance with OSHA requirements.

• Informing workers that the employer is temporarily suspending the annual fit testing of N95 filtering facepiece respirators to preserve and prioritize the supply of respirators.

• Explaining to employees the importance of user seal checks.

• Conducting additional fit tests for personnel exhibiting visual indications of factors which may challenge proper fitment (including facial scarring, dental changes, cosmetic surgery, or obvious weight gain).

OSHA Compliance Assistance

KERAMIDA is prepared to assist you in achieving compliance with any of the items above as well as the remaining standard requirements of 29 CFR 1910.134. Experienced KERAMIDA personnel are available to provide the following:

• Evaluation of current compliance status and provision of appropriate recommendations.

• Initial fit testing (not waived by this enforcement discretion directive).

• Respirator use training.

• Respiratory protection program development.

For additional details of the OSHA enforcement directive, click HERE (https:/www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit)

For additional details from the CDC regarding respirator resource preservation, click HERE (https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit)

Blog Author

Dan Engling, CIH
Director of Industrial Hygiene Services
KERAMIDA Inc.

Contact Dan at dengling@keramida.com.