A Little History
In 2009, when the H1N1 influenza outbreak occurred, the CDC’s “Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, including Protection of Healthcare Personnel” determined that long-term care facilities would need to use respiratory protection to comply with the OSHA standard.
Until the H1N1 virus emerged, most nursing home facilities did not require respiratory protection, since residents ill with tuberculosis or other infectious airborne agents were sent to acute care facilities. Now, during the COVID-19 pandemic, it is important for long-term care facilities to comply with OSHA mandates under its respiratory protection standard.
Respiratory Protection Program
Development of a written respiratory protection plan, medical evaluations for employees who may need respiratory protection, employee training, fit testing, and the necessary record keeping are all major components of a respiratory protection program.
Creating a Plan
When creating a plan, it is important for long-term care facilities to do so with care and precision. The equipment is only helpful when it is used according to how it was designed to be used. This equipment will always be the most protective against disease when it is used properly and when healthcare professionals receive proper education on the equipment. It is imperative to include medical evaluations to determine employees’ ability to use a respirator, such as an N95 mask, in the workplace. Failure to comply with these rules may result in hefty fines.
Fit Testing Methods
Fit testing methods can maximize respirator supplies and fit testing efficiency. Both initial fit testing and annual respirator fit testing are mandatory. When an employee uses a respirator, or when an employee changes to a different model, make, or size of respirator, they must undergo fit testing. In addition, fit testing must be performed annually to meet OSHA respirator protection standards.
Employers can use qualitative fit testing to help conserve respirator supplies. Qualitative fit testing does not damage the respirator. Therefore, the respirator used during the fit test can be used on the job by the employee who was tested. It is important to note that the recommended respirator extended use period is 8-12 hours and respirators should be removed and carefully stored in a clean paper bag before activities such as meals, restroom breaks, and other breaks and then re-donned and worn through the remainder of the shift. Contaminated respirators should be disposed of immediately.
Stay Proactive
Facility staff should have a heightened awareness for any change in baseline in their residents. Long-term care facilities need to remain vigilant with detection of disease, triage, and isolation of potentially infectious residents to promote unnecessary exposure among healthcare personnel and visitors at the facility. They need to implement active screening of residents and staff for fever and respiratory symptoms.
Active screening is when a member of the healthcare facility collects information from all staff and residents about symptoms. It is important to keep in mind that older adults may manifest symptoms of infection differently and that other symptomology should be used. Vital signs should include heart rate, blood pressure, temperature, pain and pulse oximetry. These assessments should happen, at a minimum, daily.
When a Long-Term Care Facility Resident is Suspected of Having COVID-19
So, what should a healthcare provider do when they must come into close contact with a resident suspected of having COVID-19? Here, we have broken this important question down into steps.
Step 1
First of all, healthcare professionals must use a NIOSH-approved N95 filtering facepiece respirator or equivalent or higher-level respirator, as required by OSHA’s Respiratory Protection Standard. The CDC guidance recommends that health care personnel follow standard and transmission-based precautions and use N95 or higher-level respirators, along with gowns, eye protection (i.e., goggles or face shield), and gloves when entering the room of a patient with confirmed or suspected coronavirus disease. Employees must be medically evaluated for the use of tight-fitting respirators, and they must be trained and properly fit tested on the specific make, model and size of respirator that will be used.
Step 2
Next, employers at long-term care facilities should reassess their engineering and administrative controls. They should consider ventilation and how to optimize for spaces that have more air coming in and out. Additionally, they need to pay special attention to physical distancing, ensuring that everyone is at least six feet part, hand hygiene, and disinfecting surfaces. It is especially important to pay attention to social distancing while residents are eating as they will not be able to wear masks while they eat.
Step 3
Continue to adjust and identify any changes that can be made to avoid over-reliance on respirators and other personal protective equipment. For example, infection prevention and control plans should limit the number of health care personnel who enter the patient’s room to only those providing direct patient care. Implementation of staffing policies to minimize the number of health care personnel who enter the room and considerations to exclude staff, such as dietary and housekeeping employees, may extend the supply of N95 respirators.
