Respiratory Protection in the Workplace

Respiratory Protection in the Workplace

According to the Occupational Health and Safety Act (OHSA) in Ontario, the employer is required to provide protection to workers when there is a respiratory hazard in the workplace. Air quality hazards that affect respiration can include particulates in the form of solids created by grinding tasks for instance or liquids created by spraying chemicals such as disinfectants. Vapours and gases, mists and dusts are all forms of respiratory hazards. Of course, in the dental industry biological hazards are of concern as these hazards are aerosolized, sneezed or coughed in the work environment.

The Hierarchy of Controls

The hierarchy of controls is a fundamental system commonly used to organize how to handle hazards in the workplace with the ultimate goal of eliminating them. When elimination is not possible, this tiered system provides a method for employers to protect workers in the control of hazards minimizing the exposure to them.  

The system is called a hierarchy based on the effectiveness of each control. Elimination is considered the most effective as the hazard no longer exists while personal protective equipment (PPE) is considered the least effective since the hazard still exists. The hierarchy of controls are described in five steps ordered in preference:

1. Elimination – physically removes the hazard
2. Substitution – finds a replacement that is less hazardous
3. Engineering – physical design/systems that reduce exposure
4. Administration – changes how work is done
5. Personal Protective Equipment – protects the worker by reducing exposure.

It is always best to eliminate the hazard first. Nonetheless, this may not always be possible especially in the case of biological hazards. For this hazard type, once engineering and administrative controls are exhausted, personal protective equipment including respiratory protection in the form of respirators will likely be required as a precaution.

Respirators

These protective devices are known commonly in the health care industry as N95 respirators. They are typically a paper-like product that filters particulates out of the air as you breathe. Officially, they are called air purifying filtering facepiece respirators and are used extensively to protect against infectious agents.  

In order to ensure the best protection, respirators of any kind require a fit test to ensure that the facepiece, or N95 respirator in this case, is sealing to the face.

Fit Testing

As per, the Canadian Standards Association (CSA) CSA Z94.4 Selection Use and Care of Respirators a fit test is described as “the use of a qualitative or quantitative method to evaluate the fit of a specific make, model and size of respirator on an individual”. Fit testing can only be performed on NIOSH approved respirators and should include the correct use of the particular respirator including donning, doffing and storage.  Workers require training.

Physical changes such as weight gain/loss, scarring or orthodontics, and changes in the make, model or size of the respirator to be worn would prompt a refreshed fit test. Fit testing should not exceed a two-year cycle and an annual cycle is recommended. Documentation of the workplace respiratory program and fit testing records for each worker requiring a respirator including personal health surveillance should be kept on record at each fit test interval.

NIOSH approved respirators

NIOSH (National Institute for Occupational Safety and Health) is a research organization with a mandate for the prevention of work-related injury and illness. They are tasked with the responsibility of monitoring and assessing the effectiveness of respirators in the marketplace.  Although a US federal agency, their product approvals are followed in Canada. Respirators sold in North America must be approved by NIOSH. Otherwise, they cannot be considered or sold as respirators.

Unfortunately, due to either a lack of knowledge or by misleading sales practices, masks are sometimes sold as respirators. Each has a different set of qualities and performance levels. Using the correct terminology for each of the respective products is critical in improving our understanding and expectations of each of the products and avoiding the proliferation of misinformation.   

Masks

These are often seen in medical and dental workplaces and used during procedures such as surgeries. They are designed for protection against large droplets and fluid. They are not designed for small droplets or fluids such as bioaerosols that may carry infectious agents. They do not provide the face-to-facepiece seal of a respirator.

Masks can be easily identified by their single strap or earloops whereas respirators have at least two straps. Correct donning of a respirator is with a strap across the back of the neck and the other at the crown of the head. Surgical masks are useful if a worker is sick and does not want to transmit the illness to others. For a healthy user, a typical surgical mask is not going to protect or prevent infection or against viruses. 

Respiratory Protection Program

Each dental office requires a respiratory protection program based on the hazards present like bioaerosols and chemicals. A hazard assessment including how the hazards are to be managed according to the hierarchy of controls should be addressed. Accommodation for either masks or respirators based on the hazard, when they are to be worn, and training needs at a minimum are to be included in the program. Refer to the safety data sheet(s) as necessary and for specific respiratory protection and hazard control information.

During emerging infectious diseases and pandemics, respirators are required in health care settings because those workers are in closest contact with patients. Since respirators require frequent changes during shifts, inventory challenges occur during outbreaks. Preparing for emergencies should be part of the workplace safety program.

Respirators may also be required during grinding of dental devices, for instance, when engineering controls like evacuation (fans) removing contaminated air are not available. The small, solid particulates contribute to poor air quality in some dental offices. In another example, molding materials are put into the air. Since workers are performing tasks in close proximity to these types of respiratory hazards the use of respirators should be worn are a precautionary measure.

Understanding respiratory protection

The incorrect use of either masks or respirators can provide workers (and consumers) with a false sense of security. Masks provide limited protection against infectious agents. A complete understanding of mask effectiveness needs to be understood to employ use during appropriate tasks. Respirators need to be fit tested to each individual and worn properly during the course of work to optimize effectiveness and work as intended. Regularly scheduled fit testing should be conducted in preparation for emergencies. By comparison, long-term care facilities and other health-related industries engage in regular fit testing for staff in the event of outbreaks.

To prevent the spread of infectious agents, pre-screening for the health of patients, avoiding hand to face contact, and proper hand hygiene including the use of hand sanitizers is also effective.  Understanding the respiratory hazard, determining the correct personal protective measure needed such as masks and respirators and the correct usage of them is critical. When it comes to respiratory protection, a NIOSH approved respirator, fit tested to the individual and worn properly is an excellent source of defense.  Dental Practice Safety is the leading occupational health and safety organization meeting the unique needs of the dental industry. We are a team of seasoned professionals certified in occupational health and safety with both the Canadian Society of Safety Engineering (CSSE) and the Board of Canadian Registered Safety Professionals (CRSP). We are bound by a code of ethics developed by each of these organizations. We have extensive experience, training and working with dental professionals. Life-long learning is our passion and helps us continue to bring exciting solutions to your industry.

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Contact Dental Practice Safety at 416.283.7233 or contact us for further information.