Medical evaluations also now required by OSHA

Workers who wear respirators must be assessed

While annual respirator fit-testing has proven to be the most controversial element of the recent federal action on TB, a new requirement for medical evaluation of employees also will affect infection control and employee health programs.

Effective July 1, 2004, the Occupational Safety and Health Administration (OSHA) will require health care workers who wear N95 respirators to receive medical evaluations. The 1998 respiratory standard that OSHA is enforcing stresses that using a respirator may place a physiological burden on employees.1 One of the minimum requirements in the medical evaluation area is for employees to be administered a questionnaire to look for possible risk factors associated with respirator use.

"They will need to medically screen everyone who is using a respirator using that questionnaire," says Bill Borwegen, health and safety director at the Service Employees International Union in Washington, DC. "If [workers] have health problems, they are going to have to undergo additional measures before they can be given an N95 respirator. To me, that is possibly an even bigger issue [than annual fit-testing]."

OSHA stressed fit-testing and medical evaluations in a recent statement announcing that health care facilities have until July 1 to begin compliance. "Requirements such as annual fit-testing and medical evaluations for covered employees may be new for some employers," said John Henshaw, administrator, in a statement. "We want to make sure they are aware of these new requirements and give them every opportunity to be able to successfully come into compliance." The mandatory medical evaluation questionnaire includes a series of yes/no questions on history of smoking, seizures, diabetes, allergic reactions, claustrophobia, and pulmonary and lung problems.

(Editor’s note: The medical evaluation questionnaire is included as "appendix c" to the 1998 respirator standard. Web:


1. Department of Labor. Occupational Safety and Health Administration. Respiratory protection; final rule. 63 Fed Reg 1,152-1,300 (Jan. 8, 1998).