Medical institutions in California must comply with the state's aerosol borne disease (ATD) standard, which has no federal equivalent. Covid-19 is a respiratory disease caused by sars-cov-2 virus. Currently, covid-19 is common in most communities in the United States and is considered to be hazardous to the workplace.
The framed warning in the guidelines states: "respirators must be provided to healthcare personnel on a regular basis, and they may be required to perform emergency aerosol generation procedures for suspected or confirmed covid-19 patients." Do not use surgical masks when respirators are required.
The guidelines include recommended engineering controls and work practices to help minimize the need for respiratory protection, as well as strategies for extending respirator use and optimizing consumables.
Engineering and work practice control includes:
Minimize the number of employees exposed to suspected and confirmed covid-19 patients and infectious aerosols by using protective covers covering the patient's head and upper body;
Whenever the staff does not use respirator, the suspicious and confirmed covid-19 patients are shielded as the source control method;
Training employees on additional preventive measures and ATD plan changes when respirators cannot be obtained or procedures such as respirator reuse or long-term use are changed; and
Inform employees and their representatives that these changes will only take effect before resuming respirator supplies and keep the status updated.
Employers must provide and ensure that all employees exposed to aerosol generation procedures use powered air purifying respirators (PAPR) or another respirator that provides equal or greater protection. If PAPR is not available and not available, N95 gas mask should be used. If so, more protective respirators should be used, such as elastic half mask or full face respirator, which are more likely to seal the face and achieve better fit.
Methods that can be used to expand the N95 respirator supply include the following:
Use reusable NIOSH certified respirators - elastic half face masks with sterile and reusable particulate filters, full face respirators and paprs, rather than disposable filtered respirators;
Use NIOSH certified industrial filter respirator approved by FDA for emergency use on March 2;
Employees are allowed to wear their own respirators if they meet cal / OSHA requirements;
Use the most suitable respirator testing method, such as qualitative fitness test, to ensure that the supply of respirator is maximized and will not damage the respirator, so the employees tested can use the respirator at work;
Use a NIOSH approved filtered face mask respirator that has expired NIOSH certification for use under specific conditions; and
Extend the life of the respirator (up to 8 to 12 hours) and store sterile filtered mask respirators in case of future shortages.
The ATD standard also applies to correctional facilities, diagnostic laboratories, and police and public health services; the agency only issued guidelines for medical institutions on August 6.