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Medical facilities face uncertainty with PPE deficiency



Lack of personal protective equipment – especially N95 masks – persists during pandemics, causing healthcare organizations to choose between saving masks or following US guidelines for fit testing, experts say.

While OSHA has released guidance that allows field offices to exercise their "discretion" when issuing citations related to fitness test violations due to lack of respiratory protection or other necessities, the federal government and state OSHA continue to cite employers.

OSHA has not been giving employers a passport and "many quotes have come out against employers related to respiratory protection … and passport testing, " said Cressinda Schlag, counselor in Austin, Texas, Jackson Lewis' office PC “It is really still up to the individual area office and also the inspector to decide whether enforcement judgment is appropriate. It is really unclear what the circumstances would be "for the investigator not to refer to violations of the respiratory guidance.

The guideline reflects the situation in reality, says Kennell Sambour, Los Angeles-based employee at Littler Mendelson PC.

"As much as hospitals are trying to follow mandatory breathing apparatus and fit testing, the reality is that there is a bottleneck in the N95s," he said. “I think this guide makes it clear to investigators that they can look at other contingency plans that hospitals have made regarding the lack of the N95. But they could have better shown that they are striving in good faith to follow them.

OSHA Guidelines require annual fit testing to be performed using a respirator. In hospitals, N95 respirators ̵

1; which block 95% of airborne particles – are among the most widely used devices to protect workers from coronavirus, which is airborne and transmitted via droplets, according to medical experts.

The most common fit test method uses an instrument to measure the mask's effectiveness in protecting against airborne pathogens, but because the test punctures the mask, it cannot be reused. And because the size of the respirator is not standardized, a fit test only covers the specific brand, brand, and model of respiratory protection used by the employee during the test, according to the U.S. Centers for Disease Control and Prevention.

On Friday, OSHA announced that it issued citations amounting to more than $ 400,000 in penalties to 25 healthcare organizations and care organizations between September 25 and October 1 for COVID-19 violations, including failure to provide respiratory certificates and proper training on use. of respiratory protection. [19659002] Breathing protection violations are generally classified as a serious violation with fines of up to $ 13,494 per violation. place and enforceable, and they will continue to be when workers return to their workplaces. "To protect employees who have to use respiratory protection for high-risk procedures," she says.

Employers need to know which employees have been tested on which equipment, including N95s but also N100s, P100s, N99s and R95s, along with brands and sizes and know exactly what they have in stock, says Bill Schwacke, Philadelphia-based care manager at Origami Risk LLC.

Hospitals need to understand their level of supply and what it might look like in the short term and "nine months ago, he said." It is difficult to do given the volatility of the situation and how often it changes. "

Health Organizations in California is facing "a completely different beast" with the California Division of Occupational Safety and Health "actively pursuing employers for not having respiratory protection both for COVID exposure and also for exposure to wildfire right now," says Schlag. "Cal / OSHA has not released any guidance or enforcement memorandum indicating that it will exercise discretion."

From 25 August to the end of September, Cal / OSHA issued 28 COVID-19-related citations to employers, including three to fit-test violations medical centers and two to medical centers for non-respiratory workers.

California employers who are unable to pass-test due to availability will need to "show that it was impossible or impossible" to comply with quoted standards, Ms. Schlag said. Cal / OSHA takes the position that employers need to have the right controls, including the right personal protective equipment, and if personal protective equipment is not available, there must be technical or administrative control that either eliminates or reduces potential exposure to the hazard. This poses a real challenge for employers. "

" I would not be surprised if we see more quotes issued, whether it is not appropriate to provide adequate fit testing or not to provide personal protective equipment, "said Sambour. "I do not expect Cal / OSHA to release this."

More insurance and workers' compensation news about the coronavirus crisis here .

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