Tuesday, August 25, 2015

Respiratory Protection Programs in Long-Term Care

Why Long-Term Care Facilities Need a Respiratory Protection Program

Every year, between 1 and 3 million serious infections occur in nursing homes, skilled nursing facilities and assisted living organizations. That number stands to grow with baby boomers quickly aging and needing additional care. As more patients enter long-term care settings, it’s critical to make sure infection control is a top priority in these organizations in order to keep both patients and staff safe and healthy.
Long-term care patients often have compromised immune systems due to their age and comorbid conditions, making them less able to fight infection. As such, elderly patients frequently contract diseases that younger or healthier individuals might not. For example, a young, healthy person with latent tuberculosis infection (LTBI) probably will not progress to active TB disease. However, an elderly patient who has previously acquired LTBI is much more susceptible for active TB disease to develop. Because of patients’ increased vulnerability, it can be very difficult to control infections in long-term care settings if an organization does not immediately and consistently employ the proper precautions.
One way to minimize the spread of infection is to have a comprehensive respiratory protection program in place. OSHA requires organizations to develop such a program to protect staff if they are exposed to airborne pathogens, such as tuberculosis, influenza, chicken pox and so on. In addition to shielding staff, a well-executed program can also ensure that patients are not infected, preserving their safety as well as their health.
Despite the OSHA requirements, long-term care organizations often don’t realize they need a respiratory protection program, believing the risks of encountering a virulent airborne illness are low. However, due to the vulnerability of this particular patient population, the chances that a facility will at some point see a patient with a fast-spreading respiratory disease, such as active TB disease, are increased. Even if the organization transfers that individual to an acute care facility, it should still have a program in place to protect staff for the time period the patient is awaiting transfer. Also, there are some cases where a novel influenza virus, such as 2009’s H1N1 outbreak, would warrant the activation of a respiratory protection program.
As long-term care facilities begin to plan their respiratory protection programs, they should keep in mind several essential components to remain compliant, effectively mitigate risk and protect patients and staff:
        Qualified Administrator
This individual should be intimately familiar with OSHA regulations and understand the potential infectious hazards an organization may face. He or she should also be aware of the necessary PPE that will adequately safeguard staff. Typically this is an N95 respirator; a device that prevents the spread of target sized particulate matter 95% of the time.
        Written Plan
Underpinning a dynamic program is a detailed document that describes how the organization shields staff from respiratory hazards and complies with OSHA regulations. This document should describe any PPE needed, as well as the required environmental controls, such as proper ventilation. To assist organizations in crafting a written plan, OSHA provides in-depth resources that outline necessary components. In particular, the agency’s small entity respiratory program compliance guide, found here, is quite helpful, including a sample plan for reference.
        Workplace Analysis
To ensure a respiratory protection program mitigates the correct hazards, long-term care organizations should conduct a workplace analysis to see what risks are, or may be, present. Organizations should take this assessment seriously as it is the only way to guarantee the selection of optimal respirators and PPE. The program administrator may want to consult external resources when conducting this assessment, such as CDC modules about specific airborne diseases.