SANTA CRUZ COUNTY
PERSONNEL ADMINISTRATIVE MANUAL

PURPOSE:

To establish policy and procedures for use of respirators for the protection of employees from exposure to airborne contaminants.

LEGAL BASIS:

California Code of Regulations (CCR), Title 8, Section 5144, Respiratory Protection, and CCR Title 8, Section 5147, Respiratory Protection for M. Tuberculosis.

DOCUMENTS:

1. Voluntary Use Employee Information Form
2. Medical Health History Questionnaire
3. Sheriff’s Respiratory Protection Program
4. Fit-test form
5. Health Services Agency – Respirator Instruction Sheet for PHNs and CHWs
6. PAPR use

POLICY:

1. This Program is mandatory for all County employees and departments.
2. The County will issue respirators based on evaluation by the County Safety Officer of County work sites and environments to identify tasks or assignments that may pose inhalation exposure hazards.
3. The County will not require or allow respirator use in any work area unless:
   1. The Safety Officer has determined that inhalation exposure hazards exist which require control; and
   2. These inhalation exposure hazards cannot be controlled sufficiently by means of engineering or administrative controls; or
   3. Employees in the work area opt to use respirators on a voluntary basis and the Voluntary Use Program procedures are followed.

PROGRAM ADMINISTRATOR

Josh Reilly, County Safety Officer, 831-454-4820

EVALUATION PROCEDURES

The Safety Officer will:

1. Request a list from each department of potentially hazardous tasks or assignments or tasks potentially requiring control of inhalation hazards.
2. Use this list to schedule hazard evaluations in each department reporting hazardous tasks or otherwise likely to assign tasks with potential inhalation hazards.
3. Perform these evaluations in the first year after this revised policy is issued. Regular re-evaluations will be performed as tasks, assignments and materials used change.
4. Issue a report detailing assignments or jobs requiring respiratory protection, based on the results of the evaluations and with assistance from the affected departments. The report will list:
   1. Departments requiring a Respiratory Protection Program
   2. Departments not requiring Respiratory Protection Program – either offering a Voluntary Use Program or having no respirator use

   Note: Departments not listed in either category have been evaluated. Jobs in these departments do not pose inhalation exposure hazards requiring any type of controls. These jobs are outside the scope of this program.

VOLUNTARY USE PROGRAM

Affected departments: General Services Department, Parks, Open Space and Cultural Services Department, and Department of Public Works.

Employee Medical Evaluations

Employees in the voluntary use program must be evaluated for medical fitness to use respirators.

Procedure

1. Supervisor receives a request to use a respirator from an employee.
2. Supervisor provides employee a copy of Medical Health History Questionnaire attached to this Program, with a sealable envelope (the Questionnaire is confidential).
3. Employee completes Questionnaire and returns to supervisor in sealed envelope.
4. Supervisor forwards completed Questionnaire to Occupational Health Physician.
5. Occupational Health Physician evaluates Questionnaire and makes a determination regarding the employee’s fitness to use respirators. Occupational Health Physician informs supervisor regarding his or her determination. Questionnaire is stored indefinitely in the files of the Occupational Health Physician.
6. Supervisor informs employee of results of medical evaluation. Supervisor provides employee with a copy of the “Voluntary Use Employee Information Form”. Employee may then purchase respirator.

Purchase of respirators

Employees must purchase their own air purifying respirators for voluntary use. Departments may opt to provide at departmental expense, air-purifying respirators for employees using them on a volunteer basis. Exception: filtering face piece-type respirators or “dust masks” will be provided at no charge to employees upon request.

Maintenance

It is the employee’s responsibility to properly maintain the respirator in accordance with the manufacturer’s recommendations and to purchase and replace the proper cartridges and other replaceable parts.

Storage

When the respirator is not in use, the employee must place it in a dry, clean storage area, away from work areas or stored supplies such as chemical products. Cabinets, storage lockers, vehicle glove boxes or zipping duffel bags are acceptable for storage for respirators.

Cleaning

Disposable N95 respirators should be discarded if they become soiled or wet. Durable, half-mask and dual cartridge respirators must be cleaned after each use and before storage. Instruction on cleaning procedures is included in the respirator packaging and will be reviewed during training for all employees using respirators (voluntary use or required).

Training

Employees in the Voluntary Use Program may opt to attend respiratory protection training on a voluntary basis.

Voluntary Use Information Form

A copy of Title 8, CCR, section 5144, Appendix D, “(Mandatory) Information for Employees Using Respirators When not Required Under the Standard”, will be provided to each employee using respirators on a voluntary basis.

RESPIRATORY PROTECTION PROGRAM

Scope

Affected departments: Health Services Agency, Sheriff’s Office (Detention Bureau), and Department of Public Works

Health Services Agency

The Public Health Nurses of the Health Services Agency have identified the following positions as regularly or occasionally involving tasks which result in elevated TB infection risks: Public Health Nurse I/II/III, Health Services Manager, Senior Health Services Manager, Health Educator, Senior Health Educator, Community Health Worker, Senior Public Health Investigator, Epidemiologist, Clinic Nurse, Medical Assistant. Environmental Health Hazardous Materials division personnel are also included.

Sheriff’s Office

Detention Bureau – These job titles are covered under this program – Sheriff’s Correctional Officers, Supervising Correctional Officers, Sergeants. Employees in these positions are likely to have contact with suspect or known infectious TB cases during inmate processing or transfer. N95 respirators are required when the evidence indicates that inmates are suspect or known infectious cases.

Sheriff’s Office – Other employees - The Sheriff’s Office has developed and will maintain its own Respiratory Protection Program for employees who may be exposed to crowd control gases, and various hazardous materials, such as illegal drug lab materials (see attached). These may include all ranks of sworn law enforcement officers.

Department of Public Works

Road crews applying hot asphalt products are covered under this program.

Respirator selection

Health Services Agency, Detention Bureau

Per CDC guidelines regarding Tuberculosis infection in clinical facilities, the County has selected disposable 3M Models 1870 and 1860 N95 respirators, for use in work in the scope of this Program. No other respirators will be used in the affected departments except as indicated in the appendices to this Program. Individual employees supervisors and managers will not select respirators nor apply any procedure for respirator selection. If a change in respirator use or a substitute respirator is required, the County Safety Officer will confer with the affected departments and make any additional selections required.

Employees in the scope of this program are required to carry or have access to N95 respirators when doing tasks in which a potential TB infection hazard or infectious respiratory illness hazard has been identified.

The HSA Environmental Health Hazardous Materials division uses Scott Air Pack 50’s (Self-Contained Breathing Apparatus) for emergency entries into environments with uncharacterized hazardous material exposures. These units have been selected due to the potential for exposures to unknown chemical air contaminants or unknown concentrations of air contaminants. The Hazardous Materials division is required to respond rapidly to leak, spill, fire, explosion or environmental contamination incidents as first or early responders. One of their jobs to attempt preliminary characterization of the nature and magnitude of exposure hazards present during emergencies and incidents throughout the County. These units provide the highest-level protection factor for employees doing these tasks in the field on an emergency basis.

Sheriff’s deputies and senior staff

The MSA Millennium air-purifying respirator and CBA/RCA canisters will be used by patrol and field staff in crowd control, drug lab actions and chemical exposure situations (see attached Respiratory Protection Program – Santa Cruz County Sheriff’s Office).

Department of Public Works

Road crews applying hot asphalt road surfacing products will use 3M 5104 (small), 3M 5206 (medium), or 3M 5304 (large) air-purifying respirator facepieces with combination particulate and organic vapor cartridges (3M 2078 and 3M 2091).

Medical Evaluation Procedures

1. Supervisor provides employee a copy of Medical Health History Questionnaire attached to this Program. The Questionnaire is confidential. A sealable envelope must be provided to the employee, in which to return the Questionnaire.
2. Employee completes Questionnaire, seals and returns to supervisor.
3. Supervisor forwards sealed, completed Questionnaire to Occupational Health Physician.
4. Occupational Health Physician evaluates Questionnaire and determines the employee’s fitness to use respirators. At his or her discretion, other medical procedures may be performed as needed to assist the physician in making a determination. Occupational Health Physician informs supervisor of his or her determination in writing. Questionnaire is stored indefinitely in the files of the Occupational Health Physician.
5. Supervisor informs employee of results of medical evaluation. The employee then contacts his or her supervisor to schedule a fit-test. If the Occupational Health Physician has not approved the employee for respirator use, the employee may not be fit-tested or use respirators. Other means will have to be used to protect the employee and get the affected tasks completed.

Fit-testing

With a record of medical approval in the employee’s file, the employee will schedule a fit-test for the types of respirators approved for the work environments. Respirator use will not be allowed until the employee has successfully completed the fit-test. The Safety Officer or other trained, qualified employees or outside vendors, will perform fit-tests, using NIOSH protocols.

An annual re-test is required. New fit-tests will be required if a decision is made to change the make and model of approved respirators. The Safety Officer must be consulted prior to any change in the respirators identified in this program. The Safety Officer will notify affected departments and staff regarding changes in the workplace or in the applicable regulations, which might affect respirator selection.

The fit-test form attached as Appendix D. will be used to record the procedure and the result. Fit-test records must be kept in the employee’s departmental file indefinitely.

Use, storage, cleaning, maintaining and discarding the N95 respirator.

When to use N95 respirators

Employees performing duties involving infectious or suspect active TB cases must use N95 respirators. County employee must carry or have access to N95 respirators where there is an elevated TB exposure risk. N95 respirators must also be available when there is an elevated risk of exposure to infectious respiratory illnesses, such as SARS or pandemic influenza. Tasks requiring respirator use may be performed when working in:

• clinic patient care areas,
• isolation rooms
• patient homes
• vehicles
• corrections facilities
• other areas with elevated infection risks

These tasks require use of N95 respirators:

• patient care in isolation rooms while occupied and for one hour after the active case has been transferred out of the isolation room.
• transporting or transferring infectious or suspect cases.
• restraint of known or suspect infectious TB cases (for Corrections Officers).
• when working in contact with known or suspect cases of infectious TB not in isolation or during transport or transfer.

Fit-checking the respirator

See the attached Health Services Agency procedure, “Respirator Instruction for PHNs and CHWs”, Attachment 4. These fitting instructions apply to all N95 wearers in the scope of this program.

All employees in the scope of this program are required to perform positive and negative fit-checks before each use. Methods will be presented in fit-testing/training sessions.

Disposing of the used respirator

These N95 respirators may be used again after an exposure situation, however, recommended practice is to dispose of the respirator after a single use. If at any time during use, the respirator is damaged, the straps are broken or loose, it becomes wet or soiled, or breathing becomes difficult, discard the respirator. Dispose of the respirator in the trash after use. If the respirator is contaminated with blood or bodily fluids, discard in a labeled infectious waste container.

Training

The supervisor will schedule training for each designated respirator user and ensure that training is completed prior to assigning the employee to perform any work requiring respirator use. Training may be offered in conjunction with fit-testing.

Training will include the following topics:

1. Need for respirator use; hazards to be controlled; how failure to use properly can result in exposures or infection.
2. Use and limitations of respirators.
3. How to tell and what to do when the respirator is not working properly.
4. How to inspect, put on and remove the respirator, how to fit-check the respirator.
5. Requirements of the Cal-OSHA standard and this Program.
6. Selection of respirators.
7. Cleaning, maintenance and storage of respirators.

The Safety Officer or trainer will issue respirators to employees after initial training is completed.

Upon successful completion of the course, training records will be filed in the employee’s file and with the Safety Officer and/or the affected department. The trained employees will be issued a certificate of completion. Annual re-training is required.

Program evaluation

This program will be evaluated annually or at regular intervals. The Safety Officer will document any programmatic failures and recommend corrective measures to the Health Services Agency or other affected departments. When tasks, assignments, clinical practices or exposure risks change, the Health Services Agency will inform the Safety Officer. Any necessary changes will be implemented by the Health Services Agency. The Safety Officer will stay informed regarding changes in respiratory protection technology and regulatory activity and will notify the affected departments of any required changes in the Program.