We normally interview our clients and other external safety professionals. This month we are looking inwards and talking to some of the Examinetics nurses. Our clients usually talk to a nurse only when they have questions, so we wanted to share their knowledge and give them a platform to share their insights.
Q - What tips do you have for someone running an occupational respiratory protection program?
KP - In order to successfully run an occupational respiratory protection program, you must understand - and then design -a program specific for your company. It should not be a one-size-fits-all solution. Why are your employees wearing respirators? To what are they exposed? What level exposures exist in your facilities? How often have employees had difficulties with respiratory illness or challenges wearing a respirator? What level of respirator protection is needed? Ask yourself these questions and then thoughtfully craft a program that solves for your specific safety needs.
Employers often do not have good program management tools. They need to track the level of respirator clearance that each employee needs, when they last received a clearance, and when they next need reevaluation. If someone has a health issues, they may need to be evaluated more frequently. They also need to note if an employee is having difficulty wearing a respirator or if the job requirements or exposures have changed. Each of these require reevaluation under the OSHA standard.
DJ - Explain to your team that the occupational respiratory program is in place to protect workers, not punish them or catch them doing something wrong. That will create engagement with your employees. When workers feel you are working against them instead of with them, it creates tension. We sometimes even feel hostility towards our techs coming into the facilities and towards us nurses on the phone. Workers seem to believe that Examinetics is demanding testing for them and requiring them to wear respirators. Express to your employees that the safety team is not the enemy, but are partnering to protect everyone in the workplace. That communication between the person running the program and their employees makes the experience more positive for all involved.
Q - How do you think COVID-19 will affect respiratory protection programs?
KP - COVID-19 is affecting respiratory protection programs in different ways. Employers are trying to keep their employees safe, while at the same time complying with regulatory requirements. For example, the American Thoracic Society (ATS) and the American College of Occupational and Environmental Medicine (ACOEM) have recommended not performing PFTs during the pandemic. So employers are going to have to balance usual best practices with new ways of keeping people safe. Examinetics has found ways to use PFT data collected within the past 2 years to support respirator clearance. Only when an employee requires an initial clearance (no previous clearances) are PFTs required, and even then only for the most strenuous use of respirators, e.g., SCBA.
Because of renewed interest in face masks, employers need to make sure they are knowledgeable about the respiratory protection standard. There is a lot to know and since many workplaces will be new to this, they may be unfamiliar with the details of regulation and compliance. Additionally, temperature screening and COVID 19 test kits are becoming part of protocols. Employers will need to consider how to make employees feel safe both in the short and long term.
DJ - I think it may be a long time before OSHA updates its guidance or makes any permanent changes to respiratory programs, so I see companies taking the lead. Immediate changes in the workplaces, including expanding existing respiratory protection programs or starting new ones, might happen on an individual level first. This will be particularly important for those wearing N95 masks for the first time, who will need to assure proper fit and appropriate use.
Q - What do you think is the future of protecting workers from respiratory hazards?
KP - Respiratory problems are among the most common occupational illnesses. I believe that employers will play an increased role in enforcing public health practices. Companies will be creating new protocols and workers will demand to know they are protected before returning to work. I can see companies strongly encouraging or even insisting that employees receive a vaccine for COVID-19 and wanting to see proof of the vaccination. The work environment is now more closely linked to overall wellbeing and employers will step up their role in protecting workers, consumers and the community. Also, expect to see changing work spaces that incorporate social distancing as part of the “normal” work environment.
DJ - I am seeing renewed emphasis on education for all employees about the correct use of respirators. Companies and people who ignored respiratory protection rules and best practices are now more interested due to the current pandemic. As an example, we are seeing a spike in requests from dentists and dental offices who want to fit test and get medically cleared. Dr. Peterson mentioned social distancing. I would like to see consistent application of appropriate distance between workers.
Q - What question do you get asked most by clients? What is the strangest question you've received?
KP - The question that we receive the most from our clients is, “Now what do I do?” Our clients often need help and direction when their employee is not cleared for a particular type of respirator. The advice that we give our clients is to have the participant call an Examinetics Medical Review Nurse to find out what to do next. Instead of going to a doctor’s office and starting the process all over, it is best to have the nurse explain exactly what is needed. The nurses will also send a follow-up letter that explains what was discussed on the telephone. That way the participant can take the letter to the doctor’s office and request specific testing based on their clearance needs.
I always find it weird when we get asked, “Why do I have to do this?” Participants often do not understand why, after all this time, they now have to complete a questionnaire when they have been wearing a respirator all along. We try to explain that their new safety manager wants to do things properly, and to closely follow the guidelines outlined by OSHA as it relates to wearing a respirator.
DJ - Sometimes I get these types of questions: “Do you think my employer is trying to use this testing to justify firing me?”, “Can I tell you something in confidence?”, “Why are you asking me such personal questions?”. This goes back to my prior point on open communication. Questions like this show we need to do a better job in explaining that we are not being big brother or monitoring performance or building a case against someone. It’s about safety. We also get asked, “Why are you making me shave?” This tells me that we as an industry need to improve in explaining the effect of facial hair in respiratory protection and enforcing this year round.
Q - What are some successful programs you’ve seen?
KP - Companies that have excellent respirator program management systems are a pleasure to work with. They know which employees need reevaluation and when it is needed. As a result their respirator program operate smoothly and efficiently.
One of the most successful programs was with a client in the building materials industry. In the beginning of their program, many employees were deferred for elevated blood pressures. This also affected the ability of the employees to receive a PFT. This meant that at the end of the testing period the client’s Nurses would have a lot of follow up and retesting to try and get their people cleared. So they began to have their Regional Corporate Nurses visit each facility and review the test results and clearance results with the employees. After a couple of years, those same folks had blood pressures that were measuring on the low side of normal, and this happened year after year. There were very few deferred clearances, and the norm was clearanceat the highest levels. To me that exemplifies what an Occupational/Compliance program can do - if you focus on the employees’ health and create a good actionable plan, it will help improve your Occupational Health and Safety as well as the overall health of your employees.