Streamlining Respirator Fit-Testing Compliance

When President Bush signed a new omnibus appropriations bill into law in December 2007, OSHA once again had the power to enforce 29 CFR 1910.134(f)(2) — a part of the Respiratory Protection for M. Tuberculosis standard that included comprehensive annual respiratory mask fit testing for all designated employees who are at risk of contact with tuberculosis.

For Kathryn Leach, Environment of Care Officer for Temple University Hospital System (TUHS), this change in OSHA's regulations had huge implications. TUHS in Pennsylvania is a vast, complex system that includes Temple University Hospital, the TUH Episcopal Campus (medical center), Jeanes Hospital and Northeastern Hospital.

What needed to be done as a result of the new regulation? "We used to fit test all our designated employees at new employee orientation," Leach said. "The process was very manageable because we had only 25 to 50 employees coming in at a time. This year, we had to do fit testing for not only all the new employees coming in but also all the existing designated employees — and we had to do it all at once for this year, and then repeat the process annually."

An "overwhelming" challenge

The new regulation meant that more than 5,000 TUHS employees would have to be fit tested within the first half of 2008 — a potential logistical nightmare for Leach. But PHS developed a system that streamlined the process for TUHS and fit tested designated employees with minimum interruption — even for those in critical care units.

Setting up the testing system was an enormous job; but, Leach said, "PHS was very helpful in giving direction, establishing the process, and showing us what steps we needed to take. They met quite frequently with a group of people from all the TUHS sites and entities."

PHS streamlines a multi-step process

TUHS identified individuals for fit testing, and PHS put the information into an Excel spreadsheet. Then, PHS provided a questionnaire that employees would fill out before being fit tested, along with preprinted medical forms to make the process even easier.

Employees filled out the questionnaire and sent it back to PHS, where a physician evaluated it and looked for "red flags" that indicated that fit testing might be problematic. If the employee "passed" this evaluation, the form was sent back to TUHS and the employee was cleared for testing. "Flagged" forms were sent to the TUHS occupational health department and reviewed along with the employee, who was then either passed or denied for fit testing.

Once an employee was cleared for testing, the employee could simply walk in and be tested — a process that was much faster than the employees expected. At the end of a successful fit test, employees received cards they could carry showing their correct mask sizes.

"In medical professions, it's very hard for employees to step away from their area," said Leach, explaining one of the main challenges PHS and TUHS faced. "PHS would say it might take eight minutes to test an individual, but it was much faster than that because PHS was ready with computer access, completed medical forms, and clearances — people were surprised that they could walk right in, be tested and get back to their unit. It was such an easy process. That was helpful for everybody!"

PHS's flexibility, mobility a key to success

The entire fit testing project lasted about six months, from project start through the actual testing, and TUHS and PHS had to work around employee summer vacations and the logistics of covering all the sites in TUHS. The fact that PHS medical technicians were able to set up their testing area in different sites, close to the employees they needed to test, was vitally important.

"One day we were stationed outside the OR and were able to test many physicians who would have a very difficult time leaving their area," Leach recalls. "PHS employees are very mobile and willing to travel to different sites, which made it much easier on our employees."

Would TUHS use PHS again?

"PHS was very timely, very helpful and professional, so I can definitely see us using them again," Leach said. "When we compared using PHS to having someone on our staff do all this — developing the process, collecting the necessary equipment, figuring everything out — it became much more cost-effective to just have PHS come in and handle it."

PHS took the burden off TUHS for establishing immediate compliance with the OSHA regulation while developing a system for the future — and the best part is that TUHS's employees are safer for it.

If you are interested in learning more about Professional Health Services' health screening programs for compliance or wellness, please contact us at 1-800-833-3005 or solutions@phsmobile.com.