OSHA: PAPRs can be used by first receivers

Multigas cartridges filter varied hazards

The Occupational Safety and Health Administration (OSHA) has another message about respiratory protection in hospitals: Think beyond infectious diseases.

Hospitals need to protect first receivers, employees who care for victims of chemical, biological, and radiological agents. A draft best practices report from OSHA states that hospitals can use powered air-purifying respirators (PAPRs) with multigas cartridges to filter contaminated air.

By contrast, first responders, such as firefighters, must use self-contained breathing apparatus (SCBA), which provide an independent air source.

Hospitals also may be able to use terrorism preparedness funds, such as the National Bioterrorism Hospital Preparedness Program of the federal Health Resources and Services Administration (HRSA), to purchase the respirators, notes Paul Penn, whose Diamond Springs, CA-based firm, EnMagine, offers consulting, planning, and training in emergency management for health care.

The OSHA document indicates a greater degree of flexibility for hospitals and a recognition of how their risks differ from that of first responders.

"Current provisions in both the Respiratory Protection Standard and the HAZWOPER [Hazardous Waste Operations and Emergency Response] standard direct responders if they are dealing with an unknown and or unquantified substance to use self-contained breathing apparatus," Penn says.

But the hazards are not the same away from the source of contamination, he adds. "The folks who are contaminated basically bring the event with them. If they arrive alive at the hospital, the level of contamination is most likely not going to warrant the use of a [SCBA] and [its] inherent hazards."

SCBAs are heavy and cumbersome. Poorly trained employees who are not accustomed to using the respirators actually could be injured by them, Penn says. The air canisters also last only 30 to 60 minutes before they need to be replaced.

The draft OSHA document isn’t a regulation. It isn’t even a guideline. But nonetheless, it provides some specific information on appropriate protection: "This PPE [personal protective equipment] guidance for first receivers specifies that employees who might come in contact with unknown hazardous substances should wear a [PAPR] with an assigned protection factor of 1,000, a chemical-resistant protective garment, head covering if it is not already included in the respirator, a double layer of protective gloves, and rubber boots. . . . As part of the hazard assessment process, each hospital also should consider the specific hazards first receivers might reasonably be expected to encounter, as identified in the hospital’s hazard vulnerability analysis. The hospital should then augment OSHA’s PPE selection, as necessary, to include protection against those specific identified hazards."

The document also notes the PPE advice applies to unknown substances and a limited quantity of the contaminant. Hospitals need to consider their special circumstances, OSHA states. For example, if hospital employees would respond to the contaminated site, they may need a higher level of respiratory protection. Hospitals facing a known hazard should gauge the level of PPE based on the material’s properties.

Hospitals also should consider how they would protect workers against a hazardous materials incident within their hospital, such as a significant spill, Penn explains.

"They should look at all the issues they are likely to confront from internal events and external events," he adds.

Meanwhile, consider all the possible needs when you buy PPE, Penn advises. For example, hospitals may be able to use the same PAPRs for infectious diseases and chemical events. But be aware of what filters the PAPR is designed to use, he says.

"Sometimes, the ones used for infection control purposes are unable to accommodate some of the more robust [filtering] systems," he says. "If the hospital is looking to use them in both environments, they should make sure they think about that before they purchase."

Training also is an important component of first receiver preparedness. In the best practices document, OSHA notes that first receivers who will decontaminate patients or handle patients before they are decontaminated must receive at least eight hours of training, as outlined in the HAZWOPER standard. Employees must receive refresher training or competency testing at least annually. The proper use of PPE is a required part of that training.

Editor’s note: A draft version of the OSHA Best Practices for Hospital-Based First Receivers from Mass Casualty Incidents Involving the Release of Hazardous Substances is available at www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html or from a link on the OSHA home page at www.osha.gov. The document includes examples of hospitals’ preparedness plans.