The National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) recently issued a Hospital Respiratory Protection Toolkit, ( to protect healthcare workers from airborne infections and other hazards.

Respirators are commonly used to protect against airborne infections like tuberculosis and are also used in healthcare for protection against chemicals and certain drugs. OSHA’s Respiratory Protection Standard requires that healthcare employers establish and maintain a respiratory protection program.

The toolkit covers respirator use, existing public health guidance on respirator use during exposure to infectious diseases, hazard assessment, the development of a hospital respiratory protection program, and additional resources and references on hospital respiratory protection programs. The document also includes an editable respiratory tool that hospitals can customize to reflect their program.

To supplement the toolkit, The Joint Commission developed an educational monograph, Implementing Hospital Respiratory Protection Programs: Strategies from the Field. It also features a case study like an overview of the respiratory protection program at Vanderbilt University Medical Center.

The respiratory protection program requirements are evaluated by a Vanderbilt working group, with input from infection control and prevention staff to determine employees who may need respiratory protection for biological infectious pathogens. Job tasks are evaluated to determine if there is work-related employee exposure to infectious agents either from lab processes or patient care, exposure to chemicals or hazardous aerosolized pharmaceuticals, or exposure to animal allergens. Standard industrial hygiene practices are applied to minimize employee exposures and minimize the number of individuals in the program.

The largest group of respirator users in the medical center program includes staff whose job duties include:

• Enter rooms where patients are on airborne precautions isolation or provide care for patients on airborne precautions in outpatient or procedural units that require the patient to remove his/her surgical face mask

• Perform certain high-risk procedures for patients on airborne precautions

• Service air-handling equipment for negative-pressure isolation rooms

Using this criteria, the total number of staff included in the program is considerable—over 8,300 persons. This number may increase significantly if a virus is pandemic (such as H1N1 or SARS at the time they first emerged) and as the CDC expands its recommendations for use of respiratory protection during patient care.