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DEPARTMENT UNIT SPECIES

Office of Environmental Health & Safety Clinical Not applicable

SOP NAME / TITLE SOP NUMBER Respiratory Protection Program 2400

EFFECTIVE DATE (must match approval/date)

DATE OF PREVIOUS VERSION

4/16/13 6/4/10

PURPOSE

The policy and procedure has been established to provide a respiratory protection program for UCSF employees. The purpose of the respirator program is to ensure all UCSF employees are protected from exposure to respiratory hazards.

INTRODUCTION

The Office of Environment, Health and Safety (OEH&S) has developed a written Respiratory Protection Program manual along with this SOP that establishes uniform policies and procedures concerning the use of respirators by UCSF employees. Respiratory protection is not intended to be used as a substitute for adequate engineering controls or proper work practices, but rather, as additional protection when it is needed.

DEFINITIONS

Air-Purifying Respirator (APR) A respirator which filters contaminants from the air via cartridges and/or filters before the air is inspired by the wearer. These are the most commonly used respirators and are available in half-mask, full-face or powered units. An APR does not supply oxygen to the user, and the contaminant must be known. Approved Respirators Tested and listed as satisfactory by the National Institute for Occupational Safety and Health (NIOSH). Canister (Air-Purifying) A container filled with sorbent, or catalyst, or a combination of these items which removes specific contaminants, i.e. gases, vapors, and/or particulates from air drawn through the unit. Canisters rely on a variety of mechanisms for contaminant removal such as chemical absorption, adsorption, catalytic action, neutralization, and mechanical filtration. Cartridge A container filled with a filter, sorbent, or catalyst, or a combination of these items which removes specific contaminant, i.e. gases, vapors, and/or particulates from air inhaled through the unit. Cartridges are smaller than canisters but are designed to work on the same principles. CBRN Cartridge A cartridge or canister that has been approved by NIOSH and protects against exposure to certain warfare agents that include chemical, biological, radiological and nuclear agents. Confined Space

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An enclosure such as a storage tank, boiler, sewer, underground utility vault, tunnel or pit that is difficult to enter or exit and may contain atmospheric or physical hazards. Contaminant An irritating or potentially harmful material (gas, vapor, or particulate) that is foreign to the normal atmosphere. Exhalation Valve A device that allows exhaled air to leave a respiratory device and prevents outside air from entering through the valve. Face piece The portion of a respirator that covers the wearer's nose and mouth (a full-face piece also covers the eyes). The face piece should make a gas-tight or dust-tight seal with the face. The facepiece is supported by headbands, and contains inhalation valves, exhalation valves and connectors for the air-purifying cartridges or filters. Filter A fibrous medium used in respirators to remove solid or liquid particulates or aerosols from the air before it enters the facepiece (this term may be used interchangeably with cartridge). Filtering face piece (dust mask) A negative pressure particulate respirator equipped with a filter as an integral part of the facepiece or with the entire face piece composed of the filtering medium. Fit Test The use of a protocol to qualitatively (QLFT) or quantitatively (QNFT) evaluate the fit of a respirator on an individual. Fume Airborne particulate formed by the evaporation of solid material e.g. metal fume emitted during welding. High-Efficiency Particulate Air (HEPA) Filter A filter designed to remove at least 99.97% of mono-dispersed particles of 0.3 microns (micrometers) in diameter. HEPA filters are often referred to as absolute filters and are used to remove toxic respirable sized particles from contaminated air. They are not designed for organic vapors adsorption or absorption. Hood A respiratory inlet covering that completely covers the head and neck and may also cover portions of the shoulders and torso. Immediately Dangerous to Life or Health (IDLH) Atmosphere An IDLH atmosphere poses an immediate threat to life, may cause irreversible adverse health effects, or could impair an individual’s ability to escape from a dangerous atmosphere. An IDLH atmosphere could include an oxygen-deficient environment (less than 19.5% oxygen), smoke, or poisonous gases. Inhalation Valve A device that allows air to enter the facepiece through the filtering media but prevents exhaled air from leaving the facepiece through the intake openings. National Institute for Occupational Safety and Health (NIOSH) A Federal agency that tests, approves, and certifies respiratory protection equipment. Oxygen-deficient atmosphere An atmosphere with oxygen content below 19.5% Particulate Matter A suspension of fine solid or liquid particles in air, i.e. dust, fog, fume, smoke or sprays. Particulate matter suspended in air is commonly known as an aerosol. Particulate Filter Series N - P - R

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Effective July 1995, new performance criteria were established for particulate respirators. The new criteria eliminates classification of particulate filters according to hazard such as "dust mist fume" and provides for three levels of filter efficiency (95%, 99%, 99.97%).These efficiencies are available in a series of filter types known as N, R, and P. These new respirators will afford a higher level of protection to a variety of workers including carpenters, painters, and farmers and medical employees requiring protection from tuberculosis. Physician or other Licensed Health Care Professional (PLHCP) An individual whose legally permitted scope or practice (i.e., license, registration, or certification) allows him or her to independently provide, or be delegated the responsibility to provide, some or all of the health care services for participants of the established respiratory protection program Powered Air-Purifying Respirator (PAPR) An air-purifying respirator that uses a blower to force the ambient air through air-purifying elements to the inlet covering. Pressure Demand Respirator A positive pressure atmosphere-supplying respirator that admits breathing air to the facepiece when the positive pressure is reduced inside the face piece by inhalation. Protection Factor The overall protection afforded by a certain type of respirator as defined by the ratio of the concentration of contaminant outside a face mask or hood to that inside the mask while in a contaminated atmosphere. For example, if a half-mask respirator has a protection factor of 10, it may provide adequate protection in atmospheres where the contaminant concentration is up to 10 times the permissible exposure limit (PEL) for that specific contaminant. Qualitative Fit Test (QLFT) A pass/fail test to assess the adequacy of respirator fit that relies on the individual’s response to the test agent, often a smell or taste testing procedure used to determine the effectiveness of the seal between the face mask and the wearer. Quantitative Fit Test (QNFT) An assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into a respirator, often a test that numerically measures particulate concentration outside of the respirator compared to the concentration inside used to assign a user specific protection factor to a specific respirator. Resistance Opposition to the flow of air, as through a canister, cartridge or particulate filter. Respirator A device designed to protect the wearer from inhalation of harmful atmospheres. Self-Contained Breathing Apparatus (SCBA) An atmosphere-supplying respirator for which the breathing air source is designed to be carried by the user, often a device worn by rescue workers, fire fighters and hazardous material response teams that provide breathable air. The term "self-contained" differentiates SCBA from other apparatus connected to a remote supply by a long hose. Supplied-Air Respirator (or airline respirator) An atmosphere-supplying respirator for which the source of breathing air is not designed to be carried by the user, often a hose-mask or hood type respirator where respirable air is supplied through an air hose connected to a compressed-air cylinder or air compressor. User Seal Check

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An action conducted by the respirator user to determine if the respirator is properly seated to the face. Vapor The gaseous state of a substance that is a solid or liquid at normal temperature and pressure.

REGULATIONS / POLICIES / GUIDELINES

Federal Link to Reference: Code of Federal Regulations

29 Code of Federal Regulations (CFR), 1910.134, General Safety Orders, Effective July 2, 2004

State Link to Reference: Cal/OSHA Standards

Title 8, California Code of Regulations (CCR), General Industry Safety Orders

Section 5144: Respiratory Protective Equipment and referenced appendices:

o Appendix A: Fit testing procedures o Appendix B-1: User Seal Check Procedures o Appendix B-2: Respirator Cleaning Procedures o Appendix C: Respirator Medical Evaluation

Questionnaire o Appendix D: Information for Employees Using

Respirators When Not Required Under the Standard. Section 5208, Append. C: Asbestos Section 5191, Append. E: Chemicals and Carcinogens Other sections, i.e. Lead (5198), Benzene (5218), Aerosol

Transmissible Diseases (ATD, 5199)

Local Link to Reference: None applicable

University of California Systemwide Link to Reference: None applicable

University of California, San Francisco Links to

references:

UCSF MC EOC Manual

UCSF Respiratory Protection SOP and

Manual

UCSF MC ATD ECP

UCSF HEIC Manual

UCSF Campus ATD ECP

UCSF EH&S Website

UCSF MC Safety Intranet Site

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PROCEDURES

Service Method and Frequency Employees who need respiratory protection may request a respirator and associated fit test any time during the year. Each employee in the program will receive annual medical reviews as required, respirator use review, re-training, and re-fit testing. A qualitative fit test (QLFT) is utilized at UCSF for fit testing negative pressure air-purifying respirators that must achieve a fit factor of 100 or less. The respirator protection factor and type of respirator influences whether a qualitative or quantitative fit test (QNFT) is performed. The role of OEH&S, Occupational Health Services, and the department supervisors are described in the Respiratory Protection Manual. Campus employees should work initially with their department-assigned EH&S Safety Advisor (DSA) to determine if respiratory protection is needed for work tasks performed. Completion of a respirator hazard evaluation (RHE, see Appendix A) form along with input from an Industrial Hygienist may be needed.

Refer to the attached Respirator Protection Manual for SCBA/PAPR and APR use procedures. Refer to the following for specific N-95 fit test procedures.

Medical Evaluation

Using a respirator may place a physiological burden on employees that varies with the type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status of the employee.

1. Occupational Health Services (OHS), a qualified physician or other licensed health care professional (PLHCP), will perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire. See medical clearance questionnaire in the reference section of this document.

2. OHS or PLHCP determines if a follow-up medical examination is necessary after evaluation of responses entered on the medical questionnaire by the employee and if necessary, shall include any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary to make a final determination.

3. Medical questionnaire and examinations are administered confidentially and during normal employee work hours or at a time and place convenient to the employee.

4. OHS or the PLHCP will be provide the following information before a recommendation concerning an employee’s ability to use a respirator can be made:

a. Type and weight of the respirator to be used;

b. The duration and frequency of respirator use (including use for rescue and escape);

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c. The expected physical work effort;

d. Additional protective clothing and equipment to be worn; and

e. Temperature and humidity extremes that may be encountered.

5. A copy of the written respiratory protection program and a copy of this section of the 5144 standard will be provided to OHS or the PLHCP.

Steps Required for an Employee to Obtain a Fit Test for N-95 Respirator or PAPR training.

1. The employee must access and complete the respiratory clearance form* available through the Occupational Health Services (OHS) website at (http://www.occupationalhealthprogram.ucsf.edu/Forms/RESPIRATOR_Clearance.pdf) or schedule an appointment with Occupational Health Services (OHS) by calling 885-7580. If the employee successfully passes the OHS respiratory clearance examination, a Medical Clearance form is sent to OEH&S and filed at the front desk should secured online viewing be unavailable. Medical Clearance data may also be securely viewed online by OEH&S.

*Completed respiratory clearance forms are faxed to OHS for review by a clinician at (415) 771-4472.

2. Medical clearance confirmation takes approximately 24-h to process. Once medically cleared, the employee must then call OEH&S (476-1300) to schedule an appointment. If a Medical Clearance form is on file, an appointment is made for this employee to be fit tested. Fit testing services are available through a variety of venues and may be conducted in staff meetings, drop-in or group sessions or at 350 Parnassus in Room 505F except on the third Thursday of the month. On this day fit testing takes place at the OEH&S office at Mt. Zion (N131). Please note that these locations are subject to change due to ongoing construction or logistical issues.

3. An employee must be clean shaven and have no other facial features that could interfere with respirator fit. Employees can be tested and trained in using a loose-fitting helmet or hooded Powered Air Purifying Respirator (PAPR), if they have facial hair that interferes with an effective respirator seal.

Conditions under which respirators are used in the workplace

1. Managers with the assistance of Hospital Epidemiology and Infection Control (HEIC), OHS, the Medical Center Safety Officer, and the Office of Environment, Health and Safety (OEH&S) are responsible for evaluating respiratory hazards in the workplace and will identify relevant workplace and user factors, and base respirator selection on these factors.

Refer to Environment of Care (EOC) Policy 1.1.2 Respiratory Protection Program and the UCSF MC Aerosol Transmissible Disease Exposure Control plan for additional information about procedures for selecting respirators for use in the workplace.

2. Respirator selection shall be adequate to protect the health of the employee and ensure compliance with all other OSHA statutory and regulatory

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requirements, under routine and reasonably foreseeable emergency situations.

3. In an IDLH atmosphere, a full face piece pressure demand SCBA certified by NIOSH for a minimum service life of thirty minutes, or a combination full face piece pressure demand SAR with auxiliary self-contained air supply must be used.

4. All oxygen-deficient atmospheres shall be considered IDLH.

5. Respirators provided only for escape from IDLH atmospheres shall be NIOSH-certified for escape from the atmosphere in which they will be used.

6. Refer to the Respiratory Protection Manual for additional requirements when performing procedures in an IDLH atmosphere.

7. For protection against gases and vapors, employees must use:

a. An atmosphere-supplying respirator OR

b. An air-purifying respirator, provided that

i. The respirator is equipped with an end-of-service-life indicator (ESLI certified by NIOSH for the contaminant); or

ii. If there is not ESLI appropriate for conditions in the workplace, implementation of a change schedule for canisters and cartridges is based on objective information and data and will ensure that cartridges and canisters are changed before the end of their service life. Follow cartridge and canister manufacturer’s suggestions at minimum for maintenance schedule.

8. For protection against particulates, the employees use:

a. An atmosphere-supplying respirator; OR

b. An air-purifying respirator equipped with a filter certified by NIOSH under 30 CFR part 11 as a high efficiency particulate air (HEPA) filter, or an air-purifying respirator equipped with a filter certified for particulates by NIOSH under 42 CFR part 84; OR

c. For contaminants consisting primarily of particles with mass median aerodynamic diameters (MMAD) of at least 2 micrometers, an air-purifying respirator equipped with any filter certified for particulates by NIOSH.

9. Facepiece seal protection:

a. Respirators with tight-fitting facepieces will not be worn by employees who have:

i. Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function; OR

ii. Any condition that interferes with the face-to-facepiece seal or valve function.

b. Employees with corrective glasses or goggles or other personal protective equipment shall ensure that such equipment is worn in a

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manner that does not interfere with the seal of the facepiece to the face of the user.

c. For all tight-fitting respirators, employees must perform a user seal check each time they put on the respirator using procedures outlined in the 5144 standard, appendix B-1. Refer to the safety guidance document “Donning and Fit-Checking N-95 Respirators” (Appendix D.) found on either the EH&S website (http://or.ucsf.edu/ehs/7555-DSY.html) or Medical Center Safety Intranet page (http://safety.ucsfmedicalcenter.org/). Or refer to manufacturer’s recommended user seal check procedures which are acceptable provided the manufacturer’s procedures are equally effective as verified by UCSF.

10. Continuing respirator effectiveness is achieved through surveillance of the work area conditions and degree of employee exposure or stress.

a. Employees must leave the respirator use area:

i. To wash their faces and respirator facepieces as necessary to prevent eye or skin irritation associated with respirator use; OR

ii. If they detect vapor or gas breakthrough, changes in breathing resistance, or leakage of the facepiece; OR

iii. To replace the respirator or the filter, cartridge, or canister elements.

iv. If an employee detects vapor or gas breakthrough, changes in breathing resistance, or leakage of the facepiece, the employee must replace or repair the respirator before returning to the work area.

Maintenance and Care of Respirators

Refer to the Respiratory Protection Manual for cleaning and disinfecting as well as storage, inspection and repair of respirators.

Breathing Air Quality and Use, Identification of filters, cartridges and canisters, Training and Information, Program Evaluation and Recordkeeping.

Refer to the Respiratory Protection Manual.

Preparation Required for a Fit Testing Session

1. The person performing the fit testing session (fitter) prepares a test solution of BitrexTM (Denatonium Benzoate) by filling the appropriate nebulizer (no.1) to just below the rim.

2. The fitter also brings out a fit test hood, the Fit Test Respirator Forms (RFTC), and copies of the Rainbow Passage, the N-95 Donning chart, a

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respirator use informational sheet, the PAPR and a supply of alcohol wipes.

Assorted sizes of N-95 disposable respirators are staged for testing. These include the Kimberly Clark (KC) Tecnol PFR-95 and 3M Model 1860 disposable respirators, in various sizes.

Fit Testing Steps

1. The employee is visually sized for the appropriate respirator mask or is allowed to pick the most acceptable respirator from a sufficient number of respirator models and sizes.

2. The employee is instructed/shown how to don the respirator, how it should be positioned on the face, how to set strap tension and how to determine acceptable fit. The donning and fit check poster may be used.

3. The employee dons the respirator for at least 5 minutes where during this this time, assessment of comfort and adequacy of respirator fit is evaluated while filling out the top section of the Respirator Fit Test Record (RFTR) form (DP-9722-001). See Appendix A.

a. Assessment of comfort includes:

i. Position of the respirator on the nose

ii. Room for eye protection

iii. Room to talk

iv. Position of the respirator on face and cheeks

b. Adequacy of the respirator fit:

i. Chin properly placed

ii. Adequate strap tension, not overly tightened

iii. Fit across nose bridge

iv. Respirator of proper size to span distance from nose to chin

v. Tendency of respirator to slip

vi. Self-observation in mirror to evaluate fit and respirator position is optional

4. The employee performs a user seal check following either the negative and positive pressure seal checks described in App. B-1 of the 5144 Respiratory Protection Standard or those recommended by the manufacturer which provide equivalent protection to the procedures in App. B-1. One can refer as well to the UCSF, “Donning and Fit-Checking N-95 Respirators” Safety Guidance document (Appendix D). Another facepiece shall be selected and retested if the employee fails the user seal check tests.

5. Fitter explains the objective of the test. The fitter also explains uses and limitations of the respirator and gives the employee an informational sheet about respirator use.

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6. If the employee exhibits difficulty breathing during the tests, she or he shall be referred to a PLHCP, as appropriate, to determine whether the employee can wear a respirator while performing her or his duties

7. If the employee finds the fit of the respirator unacceptable, the employee may select a different respirator and be retested.

8. The fit test is performed while the employee is wearing any applicable safety equipment that may be worn during actual respirator use which would interfere with respirator fit.

9. The employee is instructed to doff their respirator after 5-minutes of donning and to hold the respirator in their lap.

10. Taste Threshold Screening

a. The test hood is then placed over the employee’s head to rest on his/her shoulders with the shoulder collar oriented in the proper direction and the hood opening facing to the front. The interior space of the hood becomes the test environment.

b. Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the fitter shall spray the taste test solution into the hood enclosure through the hood opening. This nebulizer shall be clearly marked to distinguish it from the fit test nebulizer. The Threshold Check Solution is prepared by adding 13.5 mg of BitrexTM to 100 mL of 5% salt (NaCl) solution in distilled water. This taste test solution can be purchased pre-mixed. This nebulizer is labeled FT-31 Taste when charged with the taste test solution. Saccharin in lieu of BitrexTM may be used as the challenge agent when a candidate confirms they are unable to detect the BitrexTM solution. Always refer to Manufacturer’s guidance prior to preparing fit test solution.

c. To produce the aerosol, the nebulizer bulb is firmly squeezed so that the bulb collapses completely, and is then released and allowed to fully expand.

d. An initial 10 squeezes are repeated rapidly and the employee asked whether the BitrexTM can be tasted. With the employee’s mouth slightly open with tongue extended, the nozzle is directed away from the nose and the mouth of the person and the bulb of the nebulizer squeezed, releasing challenge agent into the taste test environment within the hood. See table below. This is to establish threshold at which employee will respond to challenge agent, verifying the number of sprays needed to induce potential exposure.

No. of Sprays Detected - Yes

Then Taste Threshold

Detected - No

10 Yes Recorded as 10 Additional 10 sprays

20 Yes Recorded as 20 Additional 10 sprays

30 Yes Recorded as 30 Employee cannot be fit tested with BitrexTM

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e. Correct nebulizer use means approximately 1 ml of liquid is used at a time in the nebulizer body.

f. The nebulizer shall be thoroughly rinsed in water, shaken to dry and refilled at least each morning and afternoon or at least every four hours.

g. The test hood is removed and the employee instructed to don their respirator. The test hood is replaced and fitter commences sprays from the nebulizer.

11. BitrexTM Solution Aerosol Fit Test Procedure

a. Employees who will be fit tested may not eat, drink (except plain water), smoke, chew gum for 15 minutes before the test.

b. The same hood enclosure used during taste threshold screening is used for the BitrexTM solution aerosol fit test procedure.

c. The employee is instructed to don the hood enclosure while wearing the respirator selected according to steps 3 (a), 3(b) and 4 in the section preceding taste threshold.

d. A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test solution into the enclosure. This nebulizer shall not be clearly marked to distinguish it from the screening test solution nebulizer. This nebulizer is labeled FT-32 Test when charged with the taste test solution. Saccharin in lieu of BitrexTM may be used as the challenge agent when a candidate confirms they are unable to detect the BitrexTM solution.

e. The fit test solution is prepared by adding 337.5 mg of BitrexTM to 200 ml of a 5% salt (NaCl) solution in warm water. This solution can be purchased pre-mixed.

f. As before, the employee shall breathe through his or her slightly open mouth with tongue extended, and be instructed to report if he/she tastes the bitter taste of BitrexTM.

g. The nebulizer is inserted into the hole in the front of the hood enclosure and an initial concentration of the fit test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20, or 30 squeezes) based on the number of squeezes required to elicit a taste response as noted during the screening test.

h. After generating the aerosol, the employee performs the exercises listed below

i. During the test, the employee will be asked if the test solution is detected. If test solution is detected then the respirator seal leaked. It may be necessary to try more than one respirator on the employee if a “fail” is indicated at any point during the testing.

j. Every 30 seconds the aerosol concentration shall be replenished using one half the number of squeezes used initially (5, 10, or 15).

k. After passing several test exercises (see below), the fitter indicates “pass” or “p” in each box for the appropriate test on the fit test form/record. The manufacturer, model, size and comfort boxes are completed.

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l. If the employee cannot detect the BitrexTM, then the employee will be challenged with an alternate agent (Saccharin) and if this cannot be detected, the employee will be trained to use a PAPR.

m. The employee must sign and date the backof the white sheet of the RFTR. The fitter then signs and dates the front of the sheet at the bottom. The white copy is for EH&S record keeping. The pink copy is for the employee, and the yellow copy is for the employee’s manager.

n. If the taste of BitrexTM is detected during the test, the fit is deemed unsatisfactory and the test is failed. A different respirator shall be tried and the entire test procedure is repeated.

o. A training video about respiratory protection at work is available for viewing via the EH&S website.

p. The fitter will enter the fit test date, respirator model, and respirator size into the Medical Center TrackIT database.

Test Exercises

The following test exercises are performed after the testing procedure is explained to the test subject and taste threshold has been established:

Normal breathing (NB). In a normal standing position, without talking, the subject shall breathe normally.

Deep breathing (DB). In a normal standing position, the subject shall breathe slowly and deeply.

Turning head side to side (SS). Standing in place, the subject shall slowly turn his/her head from side to side between the extreme positions on each side. The head shall be held at each extreme momentarily so the subject can inhale at each side.

Moving head up and down (UD). Standing in place, the subject shall slowly move his/her head up and down. The subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling).

Talking/reading (R). The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor. The subject reads from a prepared text entitled The Rainbow Passage.

Rainbow Passage

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow. Grimace. The subject shall grimace by smiling or frowning. (This applies

only to QNFT testing; it is not performed for QLFT) Bending over. The subject shall bend at the waist as if he/she were to

touch his/her toes. Jogging in place shall be substituted for this exercise

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in those test environments such as shroud type QNFT or QLFT unites that do not permit bending over at the waist.

Normal Breathing (NB). Same as Exercise (1).

Each test exercise shall be performed for one minute except for the grimace exercise which shall be performed for 15 seconds.

PAPR (Powered Air Purifying Respirator)

If the fitter determines that none of the respirators provide the employee with a good fit, he/she is assigned a PAPR and is then instructed on the use of the device and directed to only use the PAPR when a respirator is needed. This is noted on the form. The PAPR is also assigned to individuals that, in the judgment of the fitter, have facial hair that could interfere with a good seal of an N-95 respirator.

PAPR Use Procedure:

Note that a formal fit test is not performed for use of the PAPRs used at UCSF since loose fitting hoods are employed. Training on proper use and limitations of the units, however, must be provided to the employee. A ‘PAPR How to use’ document is provided at the time of fit testing to employees who are assigned a PAPR for respiratory protection (See Appendices F and G). The same document is available online on the Safety intranet page. PAPRs are available from Materiel Services for the Medical Center and are stored on airborne isolation carts which can be ordered from Materiel Services. The ‘PAPR How to use’ document is part of the airborne cart. Campus PAPRs are available via Campus Procurement.

Several pre-use checks of the units are required as follows:

For the MaxAire 710 CAPR/PAPR units:

1. Check all pieces of the equipment are in good condition.

2. Check the helmet, power cord, battery and visor are in good condition.

3. Attach the power cord to the helmet

4. Attach battery and observe LED lights as PAPR cycles through flow check. All green LEDs imply flow is good and unit can be used.

5. Don the unit as instructed.

6. Decontaminate equipment subsequent to use (do not use acetone or non-hospital grade disinfectants or cleansers incompatible with the equipment) and appropriately dispose of visor

For the 3M BreathEasy units still available for use at UCSF MC:

1. Ensure that the breathing hose is free of cracks and abrasions or is otherwise undamaged. Ensure that a clamp is attached to the hose which attaches to the cartridge unit.

2. Check that the loose fitting hood and face shield are undamaged and clean.

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3. Remove the small plastic cap on the cartridge prior to attaching to the battery back.

4. Attach the battery to the cartridge unit with the cord provided.

5. Perform a flow check to ensure that the unit is operational and the battery is charged. The flow meter must read a minimum of 6 liters per minute (LPM). A reading less than this may indicate lack of sufficient battery charge, or cartridge saturation.

6. Don the unit as instructed

7. Decontaminate the unit subsequent to use (do not use solvents such as acetone or non-hospital grade disinfectants or cleansers incompatible with the equipment).

At the Conclusion of Respirator Fitting

The fitter attaches the appropriate sticker on the back of the employee’s ID card. This sticker identifies his/her respirator make and size.

Medical evaluation records are retained by OHS.

Fit test and respirator training records are retained by OEHS and OHS.

General Considerations

Since the nebulizer has a tendency to clog during use, the test operator must make periodic checks of the nebulizer to ensure that it is not clogged. If clogging is found at the end of the test session, the test is invalid. Rinsing the nebulizer under running water will normally clear an obstruction.

Fit Testing Supplies required:

1. 3M FT-31 and FT-32 Fit Taste and Test Solution respectively or equivalent.

2. DeVilbiss Model 40 Inhalation Medicaton Nebulizer or equivalent. 3. Adequate number and various sizes of N-95 respirators (3M N-95 and KC

Tecnol N-95 respirators) for testing 4. Adequate number of Test hoods 5. Respirator Fit Test Record forms, Stickers for ID badge and pens 6. Respirator training guidance documents, many also available online 7. PAPR unit (MaxAir 710 CAPR/PAPR or 3M BreathEasy) for Respirator

demonstration and training of candidates who are not able to wear an N-95 respirator but whose work tasks require respiratory protection at least as protective as an N-95 Respirator or who perform high hazard procedures on patients under airborne precautions.

ADMINISTRATIVE REQUIREMENTS / DISTRIBUTION

SOP Review Schedule

Annually by EH&S

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Distribution

Campus and MC wide

Data Entry

RFTR data collected by EH&S is entered into the OHS TrackIT database

INTERNAL REFERENCES

Appendix A. Respirator Hazard Evaluation (RHE) Form (EH&S)

Appendix B. Medical Clearance form (OHS) http://www.occupationalhealthprogram.ucsf.edu/Forms/RESPIRATOR_Clearance.pdf

Appendix C. Respirator Protection Handout*

Appendix D. Donning and Fit Checking N-95 Respirator guidance*

Appendix E. Medical Center PAPR Requirement*

Appendix F and G PAPR ‘How to Use’ documents:

F. 3M BreathEasy

G. MaxAir 710 CAPR/PAPR

Appendix H. For the Task, Wear the Correct Mask: UCSF MC Respirator and Mask Selection Guidance document

Fit testing and Respirator Training packet contains handouts listed above with asterisk (*) (This packet is distributed during fit test/respirator training sessions conducted by EH&S)

Appendix I Biosafety Manual

AUTHOR / DATE: Veronica Villalon,

EH&S

4/16/2013

APPROVAL DATE:

04/16/13

Respiratory Hazard Evaluation

Name: Job Title: Date:

Department: Phone: Email:

Supervisor:

Bldg: Room:

Other Employees Performing Work Task:

Name phone Name phone

Description of Work Task:

Identity of Contaminant(s)/Hazard(s): Volume & Concentration: Duration of Exposure:

Engineering Controls and/or Personal Protective Equipment Being Used:

Expected physical work effort:

High Moderate Low

Physical Work Effort Key (based on ACGIH TLV and BEI handbook)

High: Examples of activities are sawing by hand, shoveling dry/wet sand, intermittent heavy lifting with pushing or pulling

Moderate: Examples of activities are scrubbing in standing position, walking about with moderate lifting or pushing

Low: Examples of activities are sitting with moderate arm and leg movements, standing with light work at machine or bench while using mostly arms or with some walking about

EH&S Only Occupational Exposure Monitoring: completed recommended not required Respirator: required not required Respirator type: N95 PAPR 1/2-face APR full-face APR Voluntary use of respirator (have individual complete Appendix B) Notes: Reviewed by: __________________________________ ___________________________________ DSA Date IH Date

UCSF MEDICAL CENTER OCCUPATIONAL HEALTH SERVICES

1600 Divisadero St. Box 1661 San Francisco, CA 94115

(415) 885-7580

TB Respirator Clearance (2/6/08 )

TO BE COMPLETED BY OCCUPATIONAL HEALTH SERVICES Approved for fit testing Not Approved (Referred for further medical evaluation) Restriction or Comments: ______N95 or PAPR_________________________________ _______________________________________ ___________________ Clinician Signature Date

ALL INFORMATION MUST BE COMPLETED BY EMPLOYEE FOR RESPIRATOR APPROVAL: Last Name: First Name: Date of Birth:

Department/Unit: Job Title: Work Phone: Last 4 digits of SSN:

XXX – XX -

OSHA Long Form Completed – on file in Occupational Health Services

UCSF Medical Center

Occupational Health Services 2380 Sutter, 3rd Floor Box 1661 Phone: (415) 885-7580 Fax: (415) 771-4472 Respirator Medical Evaluation Questionnaire – N95 (Respiratory Isolation Mask) (1/3/07) Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory) To the employee: Can you read? (circle one): Yes / No Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it. Part A. Section 1. (Mandatory) the following information must be provided by every employee who has been selected to use any type of respirator (please print). Name: ____________________________________________________________ Date: ________________ Address: ________________________________City ________________ State_______ Zip Code__________ Marital Status: _____________________________ Social Sec #: _________-______-___________________ (For registration purposes only) Phone # (where you can be reached by the health care professional who reviews this questionnaire): _______________ The best time to reach you at this number: ______________________ Alternate #: _____________________ Job Title:______________Department:______________________ Email:_____________________________ Sex: Male Female Height: _________ Weight: __________lbs. Birthdate: mm/dd/yy __________ Employer (check one): UCSF Medical Center____ UCSF Campus ____LPPI____ Traveler____ Other_______________________

1. Has your employer told you how to contact the health care professional who will review this questionnaire? (circle one) Yes / No 2. Have you worn a respirator? (circle one) Yes / No

If “yes”, what type (s) __________________________________________________________________

Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been selected to use any type of respirator (please indicate “yes” or “no”. 1. Do you currently smoke tobacco, or have you smoked tobacco in the last month? Yes No 2. Have you ever had any of the following conditions?

a) Seizures (fits) Yes No b) Diabetes (sugar disease) Yes No c) Allergic reaction that interfere with your breathing Yes No d) Claustrophobia (fear of closed-in places) Yes No e) Trouble smelling odors Yes No

3. Have you ever had any of the flowing pulmonary or lung problems? a) Asbestosis Yes No b) Asthma Yes No c) Chronic bronchitis Yes No d) Emphysema Yes No e) Pneumonia Yes No f) Tuberculosis Yes No g) Silicosis Yes No h) Pneumothorax (collapsed lung) Yes No i) Lung cancer Yes No j) Broken ribs Yes No k) Any chest injuries or surgeries Yes No l) Any other lung problem that you’ve been told about Yes No Please complete the back of this form…turn the page…thanks!

4. Do you currently have any of the following symptoms of pulmonary or lung illness

a) Shortness of breath Yes No b) Shortness of breath when walking fast on level ground or walking up a slight hill or incline Yes No c) Shortness of breath when walking with other people at an ordinary pace on level ground Yes No d) Have to stop for breath when walking at your own pace on level ground Yes No e) Shortness of breath when washing or dressing yourself Yes No f) Shortness of breath that interferes with your job Yes No g) Coughing that produces phlegm (thick sputum) Yes No h) Coughing that wakes you early in the morning Yes No i) Coughing that occurs mostly when you are lying down Yes No j) Coughing up blood in the last month Yes No k) Wheezing Yes No l) Wheezing that interferes with your job Yes No m) Chest pain when you breathe deeply Yes No n) Any other symptoms that you think may be related to lung problems Yes No

5. Have you ever had any of the following cardiovascular or heart problems?

a) Heart attack Yes No b) Stroke Yes No c) Angina Yes No d) Heart failure Yes No e) Swelling in your legs or feet (not caused by walking) Yes No f) Heart arrhythmia (heart beating irregularly) Yes No g) High blood pressure Yes No h) Any other heart problem that you’ve been told about Yes No

6. Have you ever had any of the following cardiovascular or heart symptoms? a) Frequent pain or tightness in your chest Yes No b) Pain or tightness in your chest during physical activity Yes No c) Pain or tightness in your chest that interferes with your job Yes No d) In the past two years, have you noticed your heart skipping or missing a beat Yes No e) Heartburn or indigestion that is not related to eating Yes No f) Any other symptoms that you think may be related to heart or circulation problems Yes No

7. Do you currently take medication for any of the following problems? a) Breathing or lung problems Yes No b) Heart trouble Yes No c) Blood pressure Yes No d) Seizures (fits) Yes No If “yes, name the medications if you know them: ____________________________________________ ___________________________________________________________________________________

8. If you have used a respirator, have you ever had any of the following problems? (If you have never used a respirator, check the following space and go to question 9) ____________

a) Eye irritation Yes No b) Skin allergies or rashes Yes No c) Anxiety Yes No d) General weakness or fatigue Yes No e) Any other problem that interferes with your use of a respirator Yes No

9. Would you like to talk to the health care professional who will review this questionnaire about answers to this questionnaire? Yes No

ASSESSMENT – TO BE COMPLETED BY A NURSE OR PHYSICIAN IN EMPLOYEE HEALTH SERVICES _____ Employee is cleared to perform job duties with use of a respirator _____ Employee needs an appointment with Employee Health Services for further evaluation _____ Other recommendations: ___________________________________________________________ Employee Health RN/NP/MD Signature____________________________________Date _______________ S:\Share\Forms\New Folder\Respirator Clearance07.doc

T:\Clinical\IH\RESPIRAT\RESPIRATFORMS\Respirator Protection Pro [Revised August 2012]

50 Medical Center Way San Francisco, CA 94143-0942 tel: 415/476-1300 fax: 415/476-0581

RESPIRATOR PROTECTION

The N95 is the respirator of choice when treating suspected/confirmed Aerosol Transmissible Disease (ATD) or tuberculosis (TB) patients. It may also be assigned as personal protective equipment (PPE) when working with chemotherapy or hazardous medications. This type of respirator has a filter-efficiency level of 95% or greater against particulate aerosols free of oil with a respiratory protection factor of 5 when used appropriately. It was designed by a qualified manufacturer and is certified by NIOSH to filter aerosolized particles of 1 micrometer in size. Tight-fitting respirators like the N95 are only effective when the seal around your nose and mouth is tight. If you cannot achieve proper fit, do not enter the isolation or treatment area.

N95 Use Limitations: The N95 does not supply oxygen. It cannot be worn in an atmosphere containing less

than 19.5% oxygen or in environments where contaminant concentrations are immediately dangerous to life and health (organic vapors, toxic gases, and toxic particulates). If the respirator becomes wet, it must be assumed that it is no longer effective and must

be replaced. If the respirator is damaged, soiled, or if breathing becomes difficult, leave the

contaminated area and dispose the respirator. The N95 cannot work with beards or other facial air, or if other conditions exist that

prevent a good seal between the face and the edge of the respirator. An alternative is discussed below. Medical clearance by Occupational Health is required prior to fit-testing. Fit-testing for the N95 respirator is required annually. Notify your supervisor that you may need an additional fit test should you experience

physical changes that could affect respirator fit. Such conditions include, but are not limited to facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.

Alternative: Powered Air-Purifying Respirators (PAPR) Powered Air Purifying Respirators (PAPR) use a battery-powered pump to provide filtered breathing air. PAPRs provide a higher level of respiratory protection than a disposable mask by providing both a barrier and a positive air current against small and large airborne particles. These respirators remove air contaminants by filtering, absorbing, or chemically reacting with the contaminants as they pass through the respirator canister or cartridge. Air is moved through the filters by a battery-operated pump when used appropriately. PAPRs provide a respiratory protection factor of 25. PAPRs can be cleaned, disinfected, and fitted with new filters for re-use.

This alternative respirator is for use only: Where adequate oxygen (19.5 to 23.5 percent by volume) is available When the wearer is unable to acquire an acceptable fit for the N95 respirator When the wearer’s facial hair prevents a good seal around the N95 respirator

See Safety Resources tab in http://safety.ucsfmedicalcenter.org/ for guidance documents related to respirators. Please contact EH&S at 476-1300 if you have questions about the Respiratory Protection Program, or if you require additional assistance with respirators not listed in this handout.

Forcefully inhale and exhale several times. The respirator should collapse slightly when you inhale and expand when you exhale. If the respirator does not collapse and expand OR if air is leaking around the edges, adjust the nosepiece and headbands as the nosepiece and headbands as described above. Perform t check again.

To perform the t check, place both hands completely over the respirator, being careful not to disturb the position, and exhale sharply. If air leaks around your nose, adjust the nosepiece as described above. If air leaks around edge, adjust the straps back along the sides of adjust the straps back along the sides of your head. Perform t check again.

Using both hands, mold the nose piece around the bridgeof your nose by pushing inwardwhile moving your ngers down both sides of the nose piece (pinching nosepiece with one hand may result in improper hand may result in improper t and less effective respiratorperformance).

Select respirator according to t test (refer to sticker on back of your ID badge) and position under your chin with nose piece up. While holding the respirator in place over nose, mouth, and chin, pull nose, mouth, and chin, pull straps over your head.

FIT CHECKING

Donning and Fit Checking N-95 Respirators

* Per Cal-OSHA regulation Title 8, Section 5199, (g) (3) (B), http://www.dir.ca.gov/Title8/5199.html

Please contact the Medical Center Safety Officer, Matt Carlson (885-3538), with any questions or concerns.

Powered Air Purifying Respirators (PAPRs) provide a higher level of respiratory protection than a fit tested N-95 respirator. PAPRs are required for high hazard procedures for patients requiring airborne precautions.* Fit tested N95 respirators must be worn during high hazard procedures for all other patients.

Diseases requiring airborne precautions include:

Novel viral pathogens Measles Chicken Pox Disseminated zoster Tuberculosis (TB)

Unknown respiratory pathogens with significant morbidity and mortality

High Hazard procedures are: 1. sputum induction 2. bronchoscopy 3. open suctioning of an endotracheal tube

or tracheostomy 4. cardiopulmonary resuscitation 5. intubation/extubation

6. aerosolized administration of medications 7. pulmonary function testing 8. autopsy, clinical, surgical and laboratory

procedures that may aerosolize pathogens

Clinical Support during High Hazard Procedures: Support personnel that are assisting and/or observing beyond 6ft from the high hazard procedure have an option to wear a PAPR or a fit tested N-95 respirator.

Do I need to be fit tested to wear PAPR equipment? No. Medical clearance and training is required. Call OEHS (476-6884) for additional information.

How to obtain a PAPR unit: Contact Materiel Services at 353-1837 to obtain a PAPR or an airborne precautions cart equipped with PAPR equipment.

Are there exemptions? Yes. If PAPRs interfere with performing required task(s), a fit tested N-95 respirator may be worn.

Current exemptions include: 1. Emergent patient condition does not allow sufficient time to don PAPR equipment. 2. PAPR equipment interferes with the use of medical devices necessary to conduct a procedure. 3. Call (476-6884) to report other potential exemptions for review and consideration.  

           

 

MCStaff_PAPR_Use_Document_March_2010medctr.doc Last Update: March 2010

Powered Air Purifying Respirator (PAPR) System User Guidance Document

I. Introduction: The purpose of this document is to provide guidance to medical staff that may need to enter a contaminated work area which requires the use of a Breath Easy™ Turbo Powered Air Purifying Respirator (PAPR) system. This document should be used as a supplement to annual respirator training required for medical staff that have been identified by Occupational Health Services (OHS) and Hospital Epidemiology and Infection Control (HEIC) for respirator use.

II. Training Requirements: PAPR training is required initially and annually thereafter. Only medical center employees that have received proper training are allowed to use a PAPR. Training is provided by OEH&S. PAPRs do not supply oxygen and should not be used in atmospheres that are oxygen deficient or

immediately dangerous to life and health (IDLH). The battery must be kept charged. PAPR maintenance and battery charging are provided by Materiel

Management. Batteries lose ~2% of their charge per day when not in use and should be maintained on trickle charge.

Prior to use, visually examine the condition of the protective hood, head suspension, face-shield and breathing tube. In addition, ensure that the proper cartridges are in place and securely mounted (Note: remove tabs from ends of cartridges when ready to use).

III. Breath EasyTM Turbo PAPR System Assembly

a. Attaching Cartridges: If not already attached (Figure 1), cartridges should be connected in the following manner. Remove screw caps from all 3 cartridges and place caps back in distribution bag. Screw all 3 cartridges into each of the 3 threaded inlets, careful not to over tighten and distort seal.

Figure 1 PAPR System without cartridges Figure 2 PAPR System with cartridges

MCStaff_PAPR_Use_Document_March_2010medctr.doc Last Update: March 2010

b. Connect Battery: Take the three pronged plug that is already attached to the PAPR system and plug it into the top of

the battery (Figures 3 & 4).

Figure 3 Figure 4

c. Flow Check: Prior to entering into a contaminated area, a flow check should be performed to ensure the PAPR system is providing a minimum of six cubic feet per minute (cfm) of air flow. Insert the end of flow tube into the PAPR outlet (Figure 5). Connect the battery to the PAPR and turn on. Green color indicates unit is on. If the float ball fails to move past the 6 cfm as indicated on the flow tube, insufficient air flow is

being provided (Figure 6). If this occurs, request another unit from Materiel Management.

Figure 5 Flow meter connected to PAPR system outlet Figure 6 Float ball is above 6 cfm arrow

d. Connecting the Breathing Tube to the PAPR system: Slide the black rubber end of the tubing (with hose clamp) over the PAPR outlet (Figure 7). Finger tighten clamp and verify that the breathing tube is secured to the PAPR unit outlet (Figure 8).

Figure 7 Figure 8

MCStaff_PAPR_Use_Document_March_2010medctr.doc Last Update: March 2010

e. Connect the Breathing Tube to the PAPR Hood: Connect the hose end to the white adapter on the protective hood (Figure 9). It should make a clicking sound as it locks into place (Figure 10).

Figure 9 Figure 10

IV. Donning Equipment:

a. Belt Attach the battery pack to the belt. Place the PAPR against your lower back with the breathing tube extended upward. The battery pack

can be placed on the side which least impedes workflow. Fasten the belt around your waist at the front so the PAPR rests comfortably and securely against

your lower back.

b. Protective Hood To achieve best fit, the head cover should be worn with the head band around your forehead and the

straps in the top of the head cover in contact with the top of your head (Figure 11). The elasticized edge of the face seal should come into contact with your face under the chin and

along the cheeks.

Figure 11

V. Cleaning Procedures • Upon removal, the wearer returns the PAPR system unit and PAPR protective hood to Materiel

Services. Materiel Services must disinfect the non-disposable pieces of equipment on the PAPR system unit (i.e. breathing tube, battery, cartridges, PAPR motor) using CaviCide ® wipe pads, or equivalent surface disinfectant product. PAPR protective hoods are disposable and should be thrown away.

• Once the non-disposable pieces of equipment are wiped down, Materiel Services places the PAPR system back on the respiratory cart with a new PAPR protective hood.

1. Align the center hole of the visor to the center mounting post on the helmet, then attach the right side and left side mounting post to visor perforations.

Visor Assembly:

Donning the PAPR:

3. Hold the helmet by the top front in one hand, then pull the helmet over and down onto the head, turn adjustment knob clockwise to tighten against back of head.

2. Loosen the rotary adjustment knob counterclockwise to ensure the helmet will easily fi t over the head.

5. To ensure a good seal, slide the fi ngers on each side of the face from under the chin and up to the temples.

4. Pull the front edge of the visor cuff down and back, under the chin to ensure a good seal.

1.

2. 3.

4. 5.

The Max Air System 710 CAPR™/ DLC System User Guidance Document

Powered Air PurifyingRespirator (PAPR)

7. Using a slight twist, connect power cord to battery.

Removing visor and doffi ng PAPR after exiting airborne isolation room:

9. Unplug the power cord from the battery. Hold the battery with one hand and grasp the power cord connector fi rmly and close to the battery connection. Gently pull the power cord connector straight out of the battery connector.

6.(a) Proper fi t is achieved when tension is felt continuously along the face, chin and;

6.(a) (b)

7. 8.

9.

(b) up to the temples. If this condition is not achieved, change visor size.

Filter and Battery LED Status Indicators:

Changing Comfort Strips:

A full comfort strip fi ts the front of the headband. To remove a damaged or soiled confort strip, pull away and off the headband.

To attach a comfort strip, align it parallel to the headband with the loop side facing the headband and press it on.

Cleaning the outer and inner surfaces of PAPR system:

Use hospital-grade disinfectant WIPES.

WARNING: Do not immerse the helmet into water or other liquid. This will cause irreparable damage to the helmet.

February 2011

Exit area prior to battery / PAPR change-out.

FOR THE TASK WEAR the CORRECT MASK: UCSF MEDICAL CENTER RESPIRATOR AND MASK SELECTION GUIDE

WHEN TO WEAR USE REQUIREMENTS

Powered Air Purifying Respirator (PAPR) Staff only:

Use PAPR (or N-95) when entering into Airborne Isolation Precautions regardless of immunity.

PAPR required when performing High Hazard Medical Procedures (i.e. sputum induction, bronchoscopy, open suctioning of an endotracheal tube or tracheosto-my ...etc.) on Airborne Isolation Precaution patients. Required when hazardous medication aerosols are pre-sent for all patients.

N-95 Respirator Staff Only:

Use PAPR (or N-95) when entering into Airborne Isolation Precautions regardless of immunity.

N95 respirator use is required with eye protection when performing High Hazard Medical Procedures on all patients except those on airborne isolation precautions.

Training required before use. Medical clearance required before use. No fit testing required. Please refer to airborne isolation or chemo precautions signage for more information. Contact Materiel Services 353-1837 (Parn) or 885-7255 (MZ) for PAPR equipment.

Must form a tight seal against the wearer’s skin. A fit-check before each use is required. Annual fit testing is required. Medical Clearance is required. Staff must only wear the respirator for which they were fit tested.

3M TECHNOL

Surgical/Exam Masks STAFF:

Required during flu season in patient care areas for all staff not vaccinated against influenza

Staff with symptoms may not work in patient care areas—see “STAY HOME/RETURN TO WORK” policy.

Wear in Surgery at the sterile field PATIENT:

Place on a patient in DROPLET or AIRBORNE Precautions, if patient is out of their room. PATIENT and VISITOR:

Provide mask if respiratory illness symptoms are pre-sent (cough, runny nose, sneezing, etc.) and/or visiting patients in DROPLET or AIRBORNE Precautions

Wear eye protection! Please anticipate potential splashes. SplashShield® mask has integrated eye protection If SplashShield® mask is not used, wear safety glasses with surgical/exam mask. Prescription eyewear does not provide sufficient protection and must be covered with safety glasses.

Questions? Safety Office 885-3538

Safety website: http://safety.ucsfmedicalcenter.org/

June 2012

SplashShield® Goggles w/ mask

WHAT TO WEAR