A Respiratory Protection Program: Why you need it and what it entails

By Richard Best
Every year, between 1 and 3 million serious infections occur in nursing homes, skilled nursing
facilities and assisted living organizations. That number stands to grow with baby boomers
quickly aging and needing additional care. As more patients enter long-term care settings, it’s
critical to make sure infection control is a top priority in these organizations in order to keep both
patients and staff safe and healthy. Long-term care patients often have compromised immune
systems due to their age and comorbid conditions, making them less able to fight infection. As
such, elderly patients frequently contract diseases that younger or healthier individuals might not.
For example, a young, healthy person with latent tuberculosis infection (LTBI) probably will not
progress to active TB disease. However, an elderly patient who has previously acquired LTBI is
much more susceptible for active TB disease to develop. Because of patients’ increased
vulnerability, it can be very difficult to control infections in long-term care settings if an
organization does not immediately and consistently employ the proper precautions. One way to
minimize the spread of infection is to have a comprehensive respiratory protection program in
place. The Occupational Safety and Health Administration (OSHA) requires organizations to
develop such a program to protect staff if they are exposed to airborne pathogens, such as
tuberculosis, influenza, chicken pox and so on. In addition to shielding staff, a well-executed
program can also ensure that patients are not infected, preserving their safety as well as their
health. Despite the OSHA requirements, long-term care organizations often don’t realize they
need a respiratory protection program, believing the risks of encountering a virulent airborne
illness are low. However, due to the vulnerability of this particular patient population, the
chances that a facility will at some point see a patient with a fast-spreading respiratory disease,
such as active TB disease, are increased. Even if the organization transfers that individual to an
acute care facility, it should still have a program in place to protect staff for the time period the
patient is awaiting transfer. Also, there are some cases where a novel influenza virus, such as
2009’s H1N1 outbreak, would warrant the activation of a respiratory protection program.

Elements in a Comprehensive Effort
As long-term care facilities begin to plan their respiratory protection programs, they should keep
in mind several essential components to remain compliant, effectively mitigate risk and protect
patients and staff:

Qualified administrator
This individual should be intimately familiar with OSHA regulations and understand the
potential infectious hazards an organization may face. He or she should also be aware of the
necessary personal protective equipment (PPE) that will adequately safeguard staff. Typically
this is an N-95 respirator-a device that prevents the spread of target sized particulate matter 95%
of the time.

A written plan
Underpinning a dynamic program is a detailed document that describes how the organization
shields staff from respiratory hazards and complies with OSHA regulations. This document
should describe any PPE needed, as well as the required environmental controls, such as proper
ventilation. To assist organizations in crafting a written plan, OSHA provides in-depth resources
that outline necessary components. In particular, the agency’s small entity respiratory program
compliance guide is quite helpful, including a sample plan for reference.

A workplace analysis
To ensure a respiratory protection program mitigates the correct hazards, long-term care
organizations should conduct a workplace analysis to see what risks are, or may be, present.
Organizations should take this assessment seriously as it is the only way to guarantee the
selection of optimal respirators and PPE. The program administrator may want to consult
external resources when conducting this assessment, such as CDC modules about specific
airborne diseases.