At Vanderbilt University Medical Center in Nashville, complying with respiratory protection is convenient, education-based — and mandatory.

Employees who have potential exposure to airborne diseases or other respiratory hazards must complete their annual fit-testing before they can receive their annual performance evaluation and raise. But Vanderbilt also works to make the training and fit-testing accessible, says Susan Johnson, MS, MT(ASCP), CSP assistant director of Vanderbilt Environmental Health and Safety and the university’s Medical Center Safety Officer.

“It’s a service that we provide. We approach it in that respect,” she says. “We try to make it as easy for the employee to be compliant as possible.”

Vanderbilt identifies employees who need to be a part of the respiratory protection program based on job descriptions and the units in which they work. The medical center takes a cautious approach; more than 8,300 of the 19,300 employees are included in the program.

Occupational health conducts the medical surveillance, while safety provides the annual fit-testing and training. Fit-testing is available as a part of competency days when nurses are completing other annual requirements, but safety also sometimes brings a fit-testing station to high-risk units.

Employees then have color-coded stickers on the back of their ID badge with information about the respirator brand and size and the date they were fit-tested.

When safety officers conduct rounds, they observe whether employees are wearing respirators when appropriate and whether they are donning and doffing them properly, says Johnson. They also check on supplies. Having easy access to the respirators is important for compliance, she says.

“Materials management, infection control, occupational health and safety — we’re all working toward the same goal,” she says. “Having that collaboration helps get the job done.”

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.