Respiratory Protection Program for Long-Term Care Facilities

Protect Your Workforce

Providing your workforce with respiratory protection against respiratory hazards, such as the virus that causes COVID-19, is a safety standard regulated and enforced by the Washington Department of Labor and Industries (L&I). Employers have an obligation to protect their employees from hazards in the workplace (General Duty WAC 296-126-094).

In healthcare facilities, the tight-fitting disposable ‘N95' respirator is a commonly used for respiratory protection. Respirator fit testing ensures that tight-fitting respirators seal properly, and helps protect employees from exposure to airborne particles such as viruses and bacteria. Keep your employees safe and working by getting them fit tested and ready to properly use a respirator.

If your facility is in an outbreak, email our Occupational Health Team at HAI-FitTest@doh.wa.gov as soon as possible and include **OUTBREAK** in the subject line.

For Fit Testing training, please see our Fit Testing Training webpage.

On-line Lunch and Learn

New! Online Lunch & Learn sessions for LTC facilities. DOH will host monthly, 30-minute sessions on topics about the respiratory protection program (see the schedule below). Each session will start at 12:00pm on Zoom. Register for the new sessions! 
  • August 17 – What makes a good RPA (Respirator Program Administrator)? 
  • September 21 – Tips on Using the 3M System for Medical Evaluations
  • October 19 – Medical Evaluation Referrals
  • November 16 – Respirator Job Accommodations
  • December 21 – Recordkeeping
  • January 18, 2023 – Fit Testing Tips 

The Five Steps of the Respiratory Protection Program

Five Steps of the Respiratory Protection Program (PDF)

Diagram of Respiratory Protection Program

DOH continues to support LTC facilities with their respiratory protection program needs. Email HAI-FitTest@doh.wa.gov if your facility needs assistance with any component of the respiratory protection program (see image above).

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).

Written Program

The written respiratory protection program is a plan for how you will provide respiratory protection for employees at your facility. It helps you identify procedures for your facility to follow in providing proper respiratory protection, medical evaluations, respirator training, respirator fit testing, etc. See Washington Administrative Code (WAC) 296-842-12005 for details about the written respiratory protection program requirements.

Why do I need a written respiratory protection program?

Because the written respiratory protection program is the facility’s plan on how to provide respiratory protection for the employees, it needs to be written down for the employees to use as a reference. It will also help new employees understand how they are to protect themselves if N95 use is necessary. See Washington Administrative Code (WAC) 296-842-12005 for details about the written respiratory protection program requirements.

For assistance developing a respiratory protection program for your facility, see the following resources and/or contact consultation services at the Department of Labor and Industries.

Respirator Medical Evaluations

Respirator medical evaluations determine whether it is safe for health care employees to use respirators. Employees complete a medical questionnaire to help identify potential health issues with respirator usage in a work setting. See WAC 296-842-14005 and WAC 296-842-22005 for more information about medical evaluation for respirator use. 

DOH will cover the cost of medical evaluations for a limited time. To enroll your employees in no-cost online respirator medical evaluations, please send the following information to HAI-FitTest@doh.wa.gov:
•    Facility/agency name, address, and facility DSHS license number
•    Contact person, email address, and phone number
•    Estimated number of employees requiring medical evaluation at your facility/agency
•    Include **MEDICAL EVALUATION** in the subject line

Which facilities/agencies are eligible for free online medical evaluations?
  • Assisted living facilities
  • Skilled nursing facilities/nursing homes
  • Adult family homes
  • Supported living agencies
  • Home care agencies
  • Home health & hospice agencies
  • Behavioral Health facilities
What is a respirator medical evaluation?

Respirator medical evaluations determine whether it is safe for health care workers to use respirators. Workers complete a medical questionnaire to help identify potential health issues with respirator usage in a work setting. See WAC 296-842-14005 and WAC 296-842-22005 for more information about medical evaluation for respirator use.

In what languages is the medical questionnaire available?
The medical questionnaire (paper form) is available in:
Amharic, Cambodian-Khmer, Chinese (simplified and traditional), English, Korean, Russian, Somali, Spanish, Tagalog, Tigrinya, and Vietnamese. Please contact us if you require an additional language.
Who can review respirator medical evaluations?

Licensed healthcare providers with occupational health or respiratory protection program expertise can do the medical evaluations. Health care facilities/agencies may do the following: hire a qualified contractor, do this in-house, or use an online respirator medical evaluation program.
DOH currently provides no-cost online respirator medical evaluations for a limited time. For more information, please email HAI-FitTest@doh.wa.gov.

My employee received a “Referred” status from the 3M online Medical Evaluation. What should I do?

If your employee received a “Referred” status from the online medical evaluation, this means the Occupational Medicine provider has determined that the employee needs to have an in-person medical evaluation.

Employer Actions

  • You can send the employee to a local occupational health clinic (one with expertise in occupational safety and health, and who is familiar with WAC 296-842 Respirators)
    • Instruct your employee to bring all information (i.e., written recommendation, etc.) with them when they go for the in-person evaluation
    • New information: 3M's online medical evaluation system will no longer mail the paperwork required for a medical evaluation referral. The instructions will be sent via e-mail. Please inform employees to use a valid email address. Should your employee need to be seen by a local occupational health clinic, have them look for the email with further instructions. If additional assistance is needed, please contact support@respexam.com directly.
  • Consider a job accommodation for the employee (such that the employee would not be assigned to areas where respiratory hazards are present) until they complete the in-person referral.

Training for Employees

After healthcare employees receive their written recommendation stating they can use a respirator, they must complete the facility’s site-specific respirator training before their first use of the respirator (WAC 296-842-16005), then annually.

What are the respirator training requirements for employees? 

The employee has a responsibility in the process also. They must take the time to learn and understand how the N95 will protect them and how to use it properly. The training should be designed specifically for the facility and include elements of their written program, such as when to use N95s. Below is a list of what the training should include. 

Training includes:

  • Why the respiratory is necessary. 
  • The respirator’s capabilities and limitations.
  • How improper fit, use, or maintenance can compromise the respirator’s effectiveness and reliability. 
  • How to properly inspect, put on, seal check, use and remove the respirator. 
  • Storing the respirators
  • How to use the respirator effectively in emergency situations, and what to do when a respirator fails
  • Medical signs and symptoms that may limit or prevent the effective use of respirators. 

Then, respirator training needs to be done every 12 months (see WAC 296-842-16005) for details about training requirements).

Employees that supervise N95 users are also required to take the training. If there is any question about respiratory protection, the employee will first go to their supervisor and their supervisor must be knowledgeable enough to troubleshoot any issue that may arise.

To help create your respirator training program, please see the resources below:


Fit Testing

The N95 protects the user when the seal around the person’s nose and mouth is tight enough to prevent the respiratory hazards from leaking into their breathing space. The fit test tests the seal of the respirator being worn by the person. There are two types of fit testing, quantitative and qualitative. DOH uses the qualitative method of fit testing.

In accordance with WAC 296-842-16005 and WAC 296-842-22010, facilities need to provide respirator fit testing for tight-fitting respirators.

The requirement for annual fit testing was reinstated as of January 1, 2022, enforceable by L&I.

For information in other languages, please visit the Adult Family Home Council webpage.

What is respirator fit testing?

Respirator fit testing is a 20-30 minute procedure to ensure a proper seal between the respirator face piece and the employee’s face. When fit tested, an employee must select and wear the same make/model/size respirator they were fitted to.

Respirator fit testing is done initially (upon hire or transfer), and then every year (within 12-months of the date of the last fit test).

NOTE: While users must perform a seal check upon donning a respirator each time, this is not a substitute for fit testing. Please see our Fit Testing Training webpage.

What are facilities/agencies required to do before fit testing?

Before workers employees at a facility/agency undergo respirator fit testing, the following steps must be completed:

  1. WAC 296-842-12005 requires facility administrators to create a respiratory protection program that describes how their employees use and store respirators. Facilities should have a written respiratory protection program in place before conducting respirator fit testing.
  2. Provide employee medical evaluations for respirator use (WAC 296-842-14005, and WAC 296-843-22005).
  3. Provide site-specific employee respirator training WAC 296-842-16005.
Where can I get fit testing?

DOH continues to support LTC facilities with fit testing needs. Email the Occupational Health Team and we will provide you with the information you will need to prepare for fit testing and connect you to the DOH fit test vendor. Or email the team with your vendor questions.

NOTE: If your facility is currently in COVID-19 outbreak status and need respirator fit testing for primary caregivers, Please include **OUTBREAK** in the subject line and be sure to also notify your Local Health Jurisdiction.

EMAIL: HAI-FitTest@doh.wa.gov

Can we conduct our own fit testing?

Yes, you can conduct your own respirator fit tests. However, learning to do respirator fit testing is a significant time commitment and can be challenging. Conducting it incorrectly can result in increased risk to employees as well as regulatory penalties.

DOH can train facilities individuals to do their own valid respirator fit testing. There is no charge for this service. For more information about fit testing training, please see our Fit Testing Training webpage.

Conducting your own respirator fit tests will maintain and sustain your Respiratory Protection Program. See WAC 296-842-15005 for more information about conducting respirator fit tests.

Recordkeeping (WAC 296-842-12010)

Written program

Keep a copy of your written respiratory protection program in a place where it is accessible to your employees. You will need to update it periodically with regulatory changes and facility changes (e.g., new types of N95s, changes in processes, etc.). 

Medical Evaluation

Medical evaluations done by a vendor: The licensed healthcare provider reviewing the medical evaluations must provide you with a written letter of recommendation for each employee who needs to wear a respirator. The letter of recommendation will need to include the date the review was done, how long it is valid, document any restrictions the person may have, and signed by the licensed healthcare provider. The current letter of recommendation must be kept on file, and it is suggested to keep 7-10 previous letters.

Medical evaluations done in-house: If you provide the questionnaire and an in-house licensed healthcare provider reviews them, the person reviewing the questionnaires must provide you with a letter of recommendation as stated above. In addition, you will need to store the medical questionnaires separate from the employee’s HR file, for 30-years after the employee terminates employment. The questionnaire contains personal health information and is covered under HIPPA. No one other than the licensed healthcare provider should review the employee’s medical questionnaire.

Training Record

You must have documentation the employee has taken the training within the year. Keep respirator training records on file for each employee.

Fit Test Record

You must have documentation the employee has been fit tested within the year. Keep respirator fit test records on file for each fit tested employee. There are specific requirements in the regulation about what needs to be in the fit test record. The fit test record must include:

  • Employee name
  • Test date
  • Type of fit test performed
  • Description of the respirator tested (type, manufacturer, model, style, and size)
  • Results of the fit test(s)

Respirator Notices

BYD Alerts

BYD Approval Date Notice

See the DSHS May 14, 2021 “Dear Provider” announcement regarding issues with BYD manufactured prior to 6/9/2020.

Action

If you have BYD respirators, check the boxes for the manufacture dates. Remove any BYD respirators manufactured before 6/9/2020.


BYD Recall notice

Specific BYD lot and serial numbers have been recalled. If you carry BYD respirators, use the link below to find the affected lot and serial numbers. D2322_Field_Action_Customer_Notification.pdf (byd.care)

Respirator User Notices Issued by Manufacturers | NPPTL | NIOSH | CDC

DSHS notice: Recalls of BYD and 3M 8210 respirators (dated September 24, 2021) 021-09-24-1.pdf (wa.gov)

Action

Check each of your BYD boxes to see if you have any of the affected respirators. If you find that you have the recalled BYD respirators, pull them out of your stock. Do not use recalled respirators!
Note: You can continue to use unaffected BYD respirators.


BYD Shelf-life Extension Notice

See the BYD extension letter (October 30, 2020) regarding extension of BYD expiration date to 5-years after the manufacturing date.

Action

If you have BYD respirators, check the boxes for the manufacturing date, and make sure the expiration dates are 5-years from the manufacturing date.

3M 8210 Respirator Alert

DSHS notice

Recalls of BYD and 3M 8210 respirators (dated September 24, 2021) 021-09-24-1.pdf (wa.gov)

Action

Check each of your 3M 8210 boxes to see if you have any of the affected respirators. If you find that you have the affected respirators, pull them out of your stock. Do not use counterfeit respirators!

Outdoor Research (OR) N95s

Notice

Outdoor Research (OR) is no longer manufacturing N95s (starting in 2021). See CDC/NIOSH notice.

Action

If your employees have been fit tested to OR respirators, do the following:

  • Use the supply that you have on-hand. If you need additional supply, contact your local LHJ if you need more OR respirators.
  • Begin re-fit testing those employees to a different make/model respirator before your supply runs low.
3M KN 9502+/N 9502+ information

T3M Particulate Respirator, 9502+N95 - Technical Specification Sheet (PDF)

If you have the 3M KN9502+, check to see if the respirators have the following stamped on the front of the respirator: 3M 9502+ N95, NIOSH, TC-84A-8637, and GB2626-2019-KN95.

  • If your KN95s have all the information listed above, you can use them as respirators for employees who are fit tested to the 3M 9502+.
  • If your KN95s do not have all the information stamped on the front, do not use these as respirators. Use them as ‘Source Control’ only.

    Note: Source control refers to the use of masks to cover a person's mouth and nose and to help reduce the spread of large respiratory droplets to others when the person talks, sneezes, or coughs. Source control masks are not to be used as respirators when employees are in areas with known respiratory hazards, such as SARS-CoV-2.

N95 Supply

Where can we get more N95s?

Be sure to purchase respirators approved by the National Institute for Occupational Safety and Health (NIOSH). Respirator filters must bear the NIOSH stamp and approval number. Purchase respirators from authorized sources.

Please verify with the manufacturer for an authorized online store/distributor.

Below are some authorized distributors:

Market Place (for 3M products)

NOTE: ‘3M 8210' and ‘3M 8210 Plus' are NOT the same size

BYD (BYD N95 DE2322)

For Small Qty – Use BYD authorized online store

For Bulk (4,800 or more): Email: bydcare@byd.com

Halyard (Duck-bill)

PROgear N95-Regular

Outdoor Research

  • Outdoor Research (OR) is no longer being manufactured. Contact your local LHJ if you need more OR respirators. Be sure employees who were fit tested to this respirator get re-fitted to a different make/model respirator.

Resources