Respirator Program Administrator

The Respirator Program Administrator or RPA has overall responsibility for the program and enough training or experience to oversee the program development, coordinate implementation, and conduct required evaluations of the program’s effectiveness.

Please note: All activities relating to the respiratory protection program should be done on paid time and at no cost to the employee (i.e., the employer pays for the employee's time, travel, and any other associated costs).

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The RPA will need to create the written respirator program, implement what needs to be done, and evaluate if what is implemented is effective to keep the workers safe from a respiratory hazard. Setting the plan/policy/procedure for any activities for the respirator program will need to include providing the workers with paid time to get their activities completed on time. Any expense related to respirator program will be paid by the employer.

The RPA is the point person at the facility that should have the most knowledge on the rules and regulations on respirator use.

The RPA may also be the person making the decisions, and/or the fit tester for the facility. Once your program is implemented and off the ground, it should become easier to maintain.

Facility leadership decisions

• Before fit test training can start, there are tasks to complete and you will need to make some decisions for your facility. 
  • Your written respirator program should be completed
  • The written program is your plan/policy/procedure on how the respirator program functions and will be a guide for the fit tester(s)
• Your worker training for N95 use will need to be completed
• The workers will need to complete this training before using their fit tested N95
• The person doing the fit testing does not need to be a healthcare provider, anyone can learn how to conduct a fit test.
• Select the staff to be trained to accommodate the number of staff that needs fit testing
  • Our recommendations:
    • 4+ fit test staff: >50 workers
    • 3-4 fit test staff: 31-50 workers
    • 2-3 fit test staff: 16-30 workers
    • 1-2 fit test staff: 1-15 workers
  • If possible:
    • Select more than 1 person to fit test staff, to cover absences
    • If staffing allows you to select more than one fit tester, select a person that is already scheduled on the off shifts, fit testing will need to be done on paid time
• Decide on how the fit testing will be done for the staff to determine how many kits you will need. If you will have more than 1 fit tester:
  • Will the fit testers be fit testing together as a team or alone?
    • If they are fit testing alone, they will need 1 kit. If they are fit testing as a team, each fit tester will need their own kit.
  • Will they need to travel to different locations to get staff fit tested?
    • If they are traveling to different locations, it is likely they will need their own kits.
• What type of fit testing will be done? Qualitative or quantitative?
  • For qualitative fit testing*:
    • What solution will you use?
      • Bitter – Bitrex
      • Sweet – Saccharine
    • What type of hood will you use?
      • Hood with a collar
      • Hood without a collar

*See the resource page for more information on fit test kits.

Medical Evaluation

As the RPA, you will need to either manage the medical evaluation or oversee someone that will manage it.

New staff that will be using the N95 will need to complete their medical evaluation before they use the N95. Remind existing staff to complete their medical evaluation when they become due. Archive staff that have left the company/employment.

In-person medical evaluation for respirator use

If your worker does not clear or pass the medical evaluation and needs to receive further evaluation, they will need to see a local medical provider. This provider should be knowledgeable of how respirators work and how using one can affect the person, especially someone with certain health conditions.

Do not send your worker to their PCP

• Their healthcare insurance will be billed, the employer is required by law to cover the cost of this expense.
• Their PCP may not know or understand the risks of using the N95 and their medical condition.

Find an occupational medicine clinic or an occupational medicine provider. When sending your worker to be evaluated further, have them bring in their job description and your facility’s work condition (e.g.  a copy of your written program) to share with the medical provider.

• It must be kept separate from the HR file.
• The questionnaire contains personal health information and therefore is HIPPA protected.
• It should not be available for supervisors to review.
• Each medical evaluation must have a letter of recommendation to inform the fit tester and the RPA if the worker is cleared to use the N95, if there are restrictions, or if further examination is required.
• The letter of recommendation should include the name of the licensed health care professional, when the medical evaluation will need to be renewed, the date it was completed, and results of review.

Medical evaluations done in-houseThe questionnaires can only be reviewed by the licensed health care professional.

Fit Testing

Remember all activities related to respirator use will need to be done on paid time for the worker. This includes getting training on how to conduct a fit test.

Anyone can learn how to conduct a fit test. There is no certification to validate this skill. However, it is the employer’s responsibility to be sure the fit testing is done correctly.

Work with your facility leadership to plan how fit testing will be accomplished. Selecting your fit test staff will depend on many things, consider the following:

The number of workers you need to fit test. The number of shifts you have. The number of building locations your organization has. The severity of staffing shortage you are experiencing.

The number of fit test kits and equipment you purchase will depend on how your Fit Testing Program is set up. Two fit testers cannot share one kit while testing at the same time.

*See the resource page for more information on fit test kits.

The equipment and solutions can be purchased separately. If you are a larger facility, consider having on hand extra:

Hoods Nebulizers Sensitivity and fit testing solutions (you cannot conduct a fit test without the solutions)

Purchase a qualitative fit test kit with either bitter or sweet solution. A qualitative fit test kit* will contain at the minimum:

• A hood
• Two complete nebulizers
• Sensitivity solution
• Fit testing solution
• Extra atomizers and cleaning wires

Qualitative Fit Test Kit

Be sure you are purchasing your N95s from a reputable distributor. Always check your new shipment of N95s for the key identifiers that will ensure your purchase is NIOSH approved N95.

During the pandemic, there were many counterfeit N95s. Always look for the NIOSH logo, manufacture name and model number, and the approval number also known as the “TC number”. If you cannot find it on your N95, look at the strap. There are some manufacturers that use the strap for that information. If you are not sure, please visit the NIOSH website NIOSH-Approved Particulate Filtering Facepiece Respirators, this site includes the N95.

Supplies

N95

It is best practice to have more than one person trained to do fit testing.

Fit testing will need to be done every year. If the person goes beyond their date for renewal, they cannot use the N95 until they get fit tested (see accommodations for more information). This is to ensure the fit on the person’s face is tight enough to protect them.

Accommodations

If a worker does not clear the medical evaluation or you do not have a N95 that fits your worker, you may want to provide accommodation. An accommodation is providing the worker an alternative work duty because they are not able to use a N95 to care for a person in isolation or quarantine with a respiratory hazard.

Examples of N95 accommodation

Assign the worker to care for residents that are not in isolation or quarantine Assign the worker to another type of job they are qualified to do that does not require them to use the N95

We recommend the following number of fit testers per number of staff:

1-2 fit test staff: 1-15 workers 2-3 fit test staff: 16-30 workers 3-4 fit test staff: 31-50 workers 4+ fit test staff: >50 workers

Employee N95 User Training

You will need to describe how you will deliver your training to your staff in your written program.

Here is an example of a description on how the training will be done:

Using a self-paced PowerPoint training to be completed before the end or the new hire orientation.

The training will need to be complete every year, just as fit testing needs to be done every year.

If you do not have any training program for your staff, you can modify the DOH Employee N95 User Training template to fit your facility. This training template is designed specifically for use in Washington State.

Recordkeeping

There are specific records you must keep and maintain. These records will help you keep track of when a worker is due to get a task done. Items you will need to keep:

The employee’s current fit test record The employee's current training record The employee’s current letter of recommendation

The written respirator program document will need to be updated as rules and regulations change or if there is a change in the facility’s plan/policy/procedure on how the N95 will be used by the workers.

It is best practice to review your written respirator program document every year, make the necessary changes and to note a review was completed.

If your facility provides the medical evaluations in-house, the questions will need to be kept for 30 years after the worker leaves your employment.

The questions are HIPPA protected and will need to be kept separate from the worker’s HR file.

Program Evaluation

The purpose of this program is to keep your workers from being exposed and getting ill. You will need to do an evaluation on your program to see if what is in place is working to keep your staff safe.

If there are barriers making it difficult for your staff to use the N95 when they need it, it will put them at risk of exposure because they will be less compliant in using it properly. You as the Program Administrator will need to investigate and find out if there are barriers to address them to make using the N95 when required easier for your staff.

Example investigative questions you may want to ask of yourself or your staff:

Have the employee’s job duties changed that may have changed the requirement to use the N95? Ask the staff how easy or difficult it is to use the N95 when it is required. Can the worker articulate and demonstrate how to don and doff the N95 properly?