COVID-19: OSHA relaxes respirator fit-testing enforcement under certain circumstances

In further recognition of the short supply of protective N95 respirators for healthcare workers treating suspected or confirmed patients with COVID-19, OSHA is relaxing enforcement of annual fit testing requirements under certain circumstances.

Those circumstances include providing workers with respirators that provide equal or higher protection than N95 medical respirators, and that initial fit testing for those respirators is still conducted to “determine if the respirator properly fits the worker and is capable of providing the expected level of protection.” The respirators must also be NIOSH-certified. 

The temporary enforcement measure is in effect until further notice. 

In a memo to OSHA regional administrators and state OSHA-designated offices, the agency said it was working in support of CDC and CMS guidance allowing the use of non-medical respirators when N95 or other such respirators were not available. In its guidance, CMS has also told its surveyors not to validate annual fit testing, if other requirements are met.

The OSHA memo reminds employers that its Respiratory Protection standard, 29 CFR § 1910.134(f)(2), “has specific requirements, including a written program, medical evaluation, fit-testing, and training, that employers must follow to ensure workers are provided and are properly using appropriate respiratory protection when necessary to protect their health.”

Employers still must provide appropriate respiratory protection for “all healthcare personnel providing direct care of these patients,” emphasized OSHA, recommending that employers refer to the CDC’s COVID-19 Hospital Preparedness Assessment Tool, found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html.

Other respirators allowed in emergency

But OSHA also noted that CDC guidelines allow for the conservation of respirators by providing healthcare workers with “another respirator of equal or higher protection, such as N99 or N100 filtering facepieces, reusable elastomeric respirators with appropriate filters or cartridges, or powered air purifying respirators (PAPR),” said the memo.

“Another measure is that healthcare employers may change the method of fit testing from a destructive method (i.e., quantitative) to a non-destructive method (i.e., qualitative). For filtering facepiece respirators, qualitative and quantitative fit-testing methods are both effective at determining whether the respirator fits properly,” said the memo, with a link to Appendix A, of OSHA’s Fit Testing Procedures.

With that guidance in mind, the memo instructed OSHA field offices to “exercise enforcement discretion concerning the annual fit testing requirement, 29 CFR § 1910.134(f)(2), as long as employers:

• Make a good-faith effort to comply with 29 CFR § 1910.134;
• Use only NIOSH-certified respirators;
• Implement CDC and OSHA strategies for optimizing the supply of N95 filtering facepiece respirators and prioritizing their use, as discussed above; 
• Perform initial fit tests for each HCP with the same model, style, and size respirator that the worker will be required to wear for protection against COVID-19 (initial fit testing is essential to determine if the respirator properly fits the worker and is capable of providing the expected level of protection);
• Inform workers that the employer is temporarily suspending the annual fit testing of N95 filtering facepiece respirators to preserve and prioritize the supply of respirators for use in situations where they are required to be worn;
• Explain to workers the importance of performing a user seal check (i.e., a fit check) at each donning to make sure they are getting an adequate seal from their respirator, in accordance with the procedures outlined in 29 CFR § 1910.134, Appendix B-1, User Seal Check Procedures. See also, OSHA tutorial videos (English, Spanish).
• Conduct a fit test if they observe visual changes in the employee’s physical condition that could affect respirator fit (e.g., facial scarring, dental changes, cosmetic surgery, or obvious changes in body weight) and explain to workers that, if their face shape has changed since their last fit test, they may no longer be getting a good facial seal with the respirator and, thus, are not being adequately protected; and,
• Remind workers that they should inform their supervisor or their respirator program administrator if the integrity and/or fit of their N95 filtering facepiece respirator is compromised.”

Maintain integrity of respirator, other requirements

The memo also noted that “workers should visually inspect the N95 respirator to determine if the structural and functional integrity of the respirator has been compromised. Over time, components such as the straps, nose bridge, and nose foam material may degrade, which can affect the quality of the fit and seal. If the structural and functional integrity of any part of the respirator is compromised, or if a successful user seal check cannot be performed, discard the respirator and try another respirator.”

Employers should be aware that other requirements under the OSHA respiratory standard will still be enforced. The memo tells OSHA offices “where the use of respiratory protection is required and an employer fails to comply with any other requirements, such as initial fit testing, maintenance, care, and training in the Respiratory Protection standard, cite the applicable section(s) of 29 CFR § 1910.134.”

For more on CDC’s Strategies for Optimizing the Supply of N95 Respirators, see https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-supply-strategies.html.

A.J. Plunkett is editor of Inside Accreditation and Quality. She can be contacted at aplunkett@decisionhealth.com.