Over the past four months we have seen the world as we know it drastically change with the advent of the COVID-19 pandemic. During this time, it has changed our work practices, how we interact with people, and perhaps most importantly, it has changed our use of personal protective equipment (PPE). Surgical masks that were typically only used by healthcare professionals are now being donned by the general public in an effort to protect themselves and to stop the spread of COVID-19. However in doing so, this has had a huge impact on supplies for the people in healthcare that need these masks to do their jobs. As a result of this, N95 use has increased in hospitals and nursing homes because there is a greater level of respiratory protection. Because of the reactive response in searching for better protection, crucial steps in healthcare settings are being missed and this might be doing more harm than good.
The surgical masks that are typically worn in healthcare settings do not prevent the inhalation of small airborne contaminants or provide any certified respiratory protection. Rather, these are used as a physical barrier protecting the user from hazards such as splashes of large droplets of blood or bodily fluid. Because of the outbreak of COVID-19, in settings where this level of protection would usually be appropriate these are no longer sufficient, and so the N95 has become more widely used. As this has happened so quickly in response to the pandemic, there has not been the same level of planning and implementation of new PPE as there perhaps normally would and for many healthcare settings across the U.S this has created a lot of problems that will not have been forecasted.
Unlike the surgical mask, an N95 is approved by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) requires any respirators with NIOSH approval to have a written respiratory protection program. This program requires businesses to complete fit testing and medical evaluations for each staff member, and the respirator that is being used must be the same make, style, size, and model every time, which has been a struggle with supply shortages. A respiratory program also requires there to be procedures and a schedule for cleaning, disinfecting, storing, inspecting, repairing, and discarding of the respirators. Those that fail to do this, put both their health and their patients at risk as well place the business in a position where they can face extensive citations from OSHA.
Most recently the U.S Department of Labor (OSHA) has cited three nursing facilities in Ohio for violating the respiratory protection standard after it was brought to their attention that seven work related hospitalizations occurred due to COVID-19. During this investigation, the business was then cited for failing to implement a comprehensive written respiratory protection program and failing to complete medical assessments to determine the employee’s ability to use a respirator. They were also issued with a Hazard Alert Letter in regard to the company’s use of N95s for up to seven days without conducting fit testing for the employees. In total, the business now faces $40,482 per fine, or $13,494 per facility.
Although this company had best intentions protecting their employees and patients by providing staff with PPE, their lack of understanding of the respiratory protection standard as well as correct fitting and donning of the N95s has ultimately risked the lives of these people. What this does show is that there are ways that workplaces can reduce the risk of exposure to COVID-19 as well as prevent violating the terms of the respiratory protection standard. One way is through the PPE that they are using. If the employees had been wearing a loose-fitting respirator, then in the first instance, they would be have been far less likely to be exposed to COVID-19 and contracting this because of the higher assigned protection factor (APF). Secondly, they would not have required fit testing or medical evaluations, meaning the businesses would have only been cited for a lack of a comprehensive written respiratory protection program which is one of the easier tasks to amend.
Under the Occupational Safety and Health Act of 1970, it is the employer’s responsibility to provide safe and healthy workplaces for their employees. OSHA plays an important role in ensuring that the Women and Men in America are kept safe by enforcing these standards and providing training, education and assistance to promote their welfare. In doing this, businesses not only protect their employees but can save themselves significant financial losses.
Flynn, M. (2020, July 23). OSHA Hands Down Safety Citations Over Improper Nursing Home PPE Use. Retrieved from Skilled Nursing News: https://skillednursingnews.com/2020/07/osha-hands-down-safety-citations-over-improper-nursing-home-ppe-use/
OSHA. (2009, May). Respiratory Infection Control: Respirators Versus Surgical Masks. Retrieved from Occupational Safety and Health Administration: https://www.osha.gov/Publications/OSHA3219.pdf
U.S Department of Labor. (2020, July 21). U.S. Department of Labor Cites Ohio Nursing Facilities for Failing to Fully. Retrieved from Occupational Safety & Health Administration: https://www.osha.gov/news/newsreleases/region5/07212020