Evaluation of a Model Training Program for Respiratory-Protection Preparedness at Local Health Departments
Alfano-Sobsey, Edie, Kennedy, Bobby, Beck, Frank, Combs, Brian, Kady, Wendy, Ramsey, Steven, Stockweather, Allison, Service, Will, Journal of Environmental Health
Historically, local health departments (LHDs) have not had extensively developed respiratory-protection programs. For most LHDs, either no such programs were in place or the programs focused only on protection against exposure to tuberculosis (TB). New respiratory threats have surfaced, however, which could affect the health of LHD employees. These threats include naturally occurring infectious diseases such as SARS, monkeypox, and avian flu, as well as deliberate aerosolization of bioterrorism agents such as smallpox viruses or anthrax spores. Drug-resistant strains of respirable biological agents are another concern, as are environmental exposures to microbial allergens and pathogens in airborne dusts and molds.
Particularly at risk for infectious-disease exposure are employees who must conduct disease investigations, staff clinics, provide vaccinations, or dispense pharmaceuticals at mass-dispensing sites. Those at risk from environmental respiratory-disease hazards include employees who must enter moldy or dusty environments. They may be involved in cleanup or assessment of community health needs after natural disasters (hurricanes, floods) or deliberate events (terrorist bombing of structures). Environmental health specialists in health departments provide key services for many of these activities and may suffer from particulate exposures. These examples should clarify some of the current respiratory hazards facing some LHD employees. A respiratory program that focuses solely on protecting employees from TB, as such programs often do, is not sufficient to ensure protection against other respiratory hazards.
Furthermore, in December 2003, OSHA revoked the existing respiratory-protection standard for TB (Occupational Exposure to Tuberculosis, 2003). Employees covered by this standard are now covered under the provisions of the respiratory-protection standard for general industry (Respiratory Protection, 1998) except that enforcement of annual fittesting with fiscal year 2005 federal moneys has been temporarily suspended for respirators worn to protect against occupational exposure to TB (Department of Labor Consolidated Appropriations Act of 2005, 2004; North Carolina Department of Labor, 2005). The newer standard is more stringent than the former TB standard. Under the regulations for general industry, OSHA requires an ongoing respiratory-protection program when employees are required to wear respirators. The Occupational Safety and Health Division of the North Carolina Department of Labor has adopted the federal OSHA respiratory-protection standard (North Carolina Department of Labor, 2002), and the standard applies to local governments as well as industries. Therefore, LHDs may have to devote scarce resources and time to developing a program that meets OSHA standards. Furthermore, the OSHA respiratory-protection standard was initially developed to address respiratory protection in an industrial working environment. Consequently, program initiation and development templates appropriate for health departments were not available. For these reasons, Public Health Regional Surveillance Team (PHRST) industrial hygienists and the North Carolina Office of Public Health Preparedness and Response have developed a training program to facilitate the implementation of complete respiratory-protection programs at LHDs.
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North Carolina's Respiratory-Protection Preparedness Training Program
N-95 respirators are recommended for the safety of employees who may be exposed to low levels of certain respiratory infectious agents in the health care environment (Centers for Disease Control and Prevention [CDC] 2005, 2004, 2003). Therefore the respiratory training program developed for LHD employees was initially based on the use of N-95 respirators. This program included information presented on the following elements of a respiratory-protection program as required by the federal OSHA Respiratory Protection Standard 1910. …