Respiratory Protection Considerations for Health Care Exposures to COVID-19

The potential spread of COVID-19 is top of mind for employers. For employers in the health care sector, including senior living and social services providers, respiratory protection is key in maintaining a healthy work environment and reducing the spread of this virus.

Listed below are considerations for employers when determining how to provide adequate respiratory protection under the current COVID-19 pandemic circumstances:

  1. Monitor and understand interim vs. permanent OSHA regulatory guidance/expectations for Personal Protective Equipment (PPE). Be prepared to implement or return to required standards of PPE usage once supplies become available.
  2. Contact your primary medical supply vendor as well as several alternatives to acquire or ensure your name is on the list to order N95 or higher protection factor respirators and a qualitative fit testing kit. Keep all documentation of orders and attempts to procure PPE. OSHA has also clarified guidance in the event all PPE vendors have been depleted:

“Due to the shortage of respirators, employers are encouraged to use the best available alternative, which sounds like surgical masks […]. While this isn’t ideal, OSHA understands there’s a shortage and it’s out of the employer’s control.

With that said, the employer should document their attempt to purchase the appropriate respirator. An email or other documentation from the supplier stating that the PPE is out of stock and unavailable should be stored in the respirator program for reference. Employers should plan on switching back to the appropriate respirators as soon as they can acquire them.” – Thomas Kenaga, OSHA

  1. Develop a plan/strategies to optimize your supply of respirators and other necessary PPE:
    • Identify the limited employees on each shift that will wear respiratory protection to provide close care to residents with suspected/ confirmed COVID-19 infection;
    • Determine what best available alternative respirators or other PPE can be procured;
    • Decide if an ample supply of surgical/ loose fitting facemasks are on-hand to give symptomatic residents and for employees to utilize if no respirators are available;
    • Document attempts to purchase appropriate respiratory protection and plan on switching back to appropriate respirators as soon as acquired;
    • Establish a plan if re-using PPE according to CDC/ OSHA guidelines.
    • Control access to critical PPE supplies.The shift nursing leader should be overseeing access and use based on the plan and requirements of use
    • Conduct training to ensure staff maintain donning and doffing procedures to avoid contact with contaminated PPE; and
    • Contact your local public health authorities to understand how they may be able to help with procuring PPE.
    • Implement other recommended controls for specific worker groups (i.e.: healthcare) and their employers.

In addition to adequate respiratory protection, the CDC is also recommending appropriate gowns, gloves, eye protection and facemasks.

Guidance for health care providers on limited personal protective equipment

The Wisconsin Department of Health Services sent out a bulletin on Tuesday, March 17th regarding the “limited supply of personal protective equipment (PPE) from the Strategic National Stockpile (SNS) that will be distributed to Wisconsin”.

Per that bulletin, health care providers, including senior living and social services providers, should be aware of the following:

  • As a requirement to receive any SNS resources, hospitals are required to use EMResource to update their hospital status on a daily basis (by 9 a.m.).
  • The stockpile of personal protective equipment (PPE) coming to Wisconsin is extremely limited. It consists of extremely small numbers of: N95 respirators, surgical masks, face shields, gowns, coveralls, and gloves.
  • Hospitals and senior living and social services providers should be optimizing current inventories of PPE per the CDC guidance. 
  • Hospitals and senior living and social services providers are encouraged to enroll and update data in EMResource, and will be notified via EMResource and WHA when supplies become available. The order form and instructions will be posted on the DHS Outbreak page.

Takeaways

Employers are encouraged to have a written Respiratory Protection Program that addresses adequate respiratory protection for employees in health care sectors during the COVID-19 pandemic. Respirators, such as the N95 Respiratory protection, may not be available and contingency plans should be in place, including the use of surgical or dust masks. Hospitals and senior living and social services providers should be aware of the guidance set forth by their state health departments, and take the necessary steps to receive PPE.

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