TB PROTECTIVE EQUIPMENT G-170 FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
EFFECTIVE DATE: 01-18-05 REVISED: 05-01-05
AUTHORITY: Sheriff M. Mims APPROVED BY: Captain M. Leonardo and Dr. K. Bird
REFERENCE: California Code of Regulations, Title 8, Section 5144; Cal-OSHA standards;
and 29 CFR Part 1910.134(c).
PURPOSE:
The purpose of this policy is to establish guidelines for the use of personal respiratory
protection by staff to reduce the risk of becoming exposed to tuberculosis (TB).
POLICY:
It is the policy of the Fresno County Sheriffs Department Detention Bureau to maintain an
Infectious Disease Exposure Control Program which is designed to eliminate or minimize
employee exposure. The Jail Medical Services Unit will maintain this program.
It is the policy of the Fresno County Sheriffs Department Detention Bureau that the prevention
and control of TB must be regarded as a priority health issue due to the possibility of airborne
transmission of TB infection in the correctional setting.
PROCEDURES:
I. PREVENTION AND CONTROL
A. The physical environment (communal spaces, shared cells, etc.) within
correctional facilities is conducive to airborne transmission of infection
among inmates, staff and visitors. This factor, coupled with the increasing
numbers of HIV-positive and at-risk inmates within jails makes the control of
TB essential within the jail facilities.
1. Qualified medical staff shall screen all incoming inmates for symptoms
and history of TB and prior Purified Protein Derivative (PPD) testing
during the initial intake screening.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
2. Any inmate with a positive PPD reaction history and inmates with
symptoms suggestive of active pulmonary TB shall be scheduled for a
chest X-ray and referred to the Medical Director.
II. ISOLATING OFFENDERS
A. Individuals with suspected or confirmed infectious TB or other significant
respiratory infectious disease that requires airborne infection isolation, shall
be identified and shall be-
1. Provided with disposable tissues and hand hygiene materials, masked
and segregated. Surgical masks will be used to mask inmates.
2. Confirmed cases shall be placed in a Negative Pressure Cell within five
(5) hours from the time of identification.
3. The inmate shall be instructed on the rationale and importance for the
use of the mask and the isolation cell.
B. If a Negative Pressure Cell is not available, the inmate shall be isolated and
transported on a priority basis to University Medical Center and placed into a
functioning Negative Pressure Room within five (5) hours from the time of
identification.
III. RESPIRATORY PROTECTION
A. The N95 respirators selected for use by the Fresno County Sheriff's
Department have been approved by the National Institute for Occupational
Safety and Health (NIOSH).
1. The 3M 8210 (Med/Lg) is the most commonly fitted respirator, as it fits
approximately 95% of the adult population.
2. The vast majority of the remaining (5%) of the population will fit into the
alternative 3M 8210 (Small) respirator.
3. Alternative measures will be taken for those unable to fit into either of
the 3M 8210 respirators on a case-by-case basis.
B. Respirators are required to be worn when-
1. In the presence of an inmate with suspected or confirmed infectious TB
who is unable or unwilling to wear a mask.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
2. Entering a room which has been occupied by an inmate with suspected
or confirmed infectious TB, prior to the time required for at least 99% of
the airborne contaminants to be removed from the room (approximately
one hour).
3. Transporting or accompanying an inmate with suspected or confirmed
infectious TB in an elevator or enclosed vehicle (even if the inmate is
wearing a mask).
C. The respirators will be provided, fit tested and maintained by the Infection
Control Nurse or their designee. The N95 respirators are located in the
following areas-
1. All medical stations and medical storage areas
2. Main Jail Booking
3. Main Jail 2nd Floor Security
4. North and South Sergeants' Offices
5. Satellite Administrative Office
D. Respirators will be made available to any affected visitors, civilian staff,
volunteers, repairmen and inmate workers.
E. The respirators are not for use with beards or other facial hair that prevents
direct contact between the face and the sealing surface of the respirator.
IV. FITTING INSTRUCTIONS
A. Each time the respirator is worn:
Iln'�II T
1. Cup the respirator in your hand, with the nosepiece at your
fingertips, allowing the headbands to hang freely below your
hand.
2. Position the respirator under your chin with the nosepiece up.
3. While holding the respirator in place, pull the top strap overir
your head so it rests high on the back of your head above
your ears.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
4. While continuing to hold the respirator firmly in place, pull the
bottom strap over your head and position it around your neck, �
below your ears. Untwist the straps. Position the respirator
4
low on your nose.
5. Place your fingertips from both hands at the top of the metal
nosepiece. Using both hands starting at the top, mold the
nosepiece to the shape of your nose by pushing inward while
moving your fingertips down both sides of the nosepiece.
Note: Always use two hands when molding the nosepiece. Pinching
with one hand may result in improper fit and less effective respirator
performance.
B. A user seal check shall be conducted by the wearer to determine
whether the respirator is properly seated to the face. To perform
the positive pressure fit check, place both hands completely over
the respirator, being careful not to disturb the position of the respirator, and
exhale. If air leaks around the nose, readjust the nosepiece as described in
Step #5 above. If air leaks at the respirator edges, adjust the straps back
along the sides of your head, and/or pull and tighten the ends of the elastic
bands. Perform fit check again if an adjustment is made.
C. If corrective glasses, goggles or other personal protective equipment is worn,
ensure that such equipment is worn in a manner that does not interfere with
the seal of the facepiece to the face of the user.
D. If a proper seal cannot be achieved, do NOT enter the isolation or
contaminated area. Notify your supervisor.
V. REMOVAL INSTRUCTIONS
A. To remove the respirator:
111311 �
1. Hold the respirator in one hand to maintain the respirator's
position on the face. Pull the bottom strap over the head.
2. Still holding respirator in position, pull the top strap over the
head.
3. Remove respirator from face and store or discard, as
applicable.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
VI. REPLACEMENT AND DISPOSAL
A. Each respirator is to be inspected prior to each use to assure there are no
holes in the breathing zone other than the punctures around staples and no
damage has occurred. Enlarged holes resulting from ripped or torn filter
material around staple punctures are considered damage. Immediately
replace respirator if damaged. (Staple perforations do not affect NIOSH
approval.)
B. Respirators may be used until damaged, breathing becomes difficult, or
contaminated with blood or body fluids. Used respirators are normally
disposed of at the end of the duty shift. Non-contaminated respirators may
be disposed of in any trash receptacle.
C. Respiratory masks will be replaced when they become wet, torn and/or
contaminated with blood or other potentially infectious materials.
Contaminated masks will be disposed of as bio-hazardous waste.
VI I. EXPOSURE INCIDENTS
A. When a physician or other licensed health care professional determines that
an employee has been exposed to a suspected or confirmed infectious TB
patient, they shall notify the on-duty Watch Commander and the affected
employee as soon as feasible.
B. The Watch Commander shall ensure that each employee who has had an
exposure incident is notified of his/her exposure.
C. Appropriate contact investigation and follow-up will be made by Jail Medical
Services staff in coordination with the Department of Community Health
Chest Clinic.
D. When an exposure incident results in a TB test conversion-
1. The employee shall be placed on medical leave until determined to be
noninfectious.
2. A determination shall be made of the drug susceptibility and resistance
of the TB strain in the case of TB disease.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
E. When an exposure incident or a TB test conversion occurs, the Infection
Control Nurse shall investigate and document the circumstances surrounding
the exposure incident or conversion (e.g., failure of engineering controls or
work practices and events leading to the exposure incident) to determine if
changes can be instituted to prevent similar occurrences in the future.
F. Any employee who believes they may have experienced an exposure
incident may request to receive a Mantoux Test.
Vill. WRITTEN OPINION
A. The Watch Commander shall obtain and provide the employee with a copy of
the written opinion of the physician within 15 days of the completion of all
medical evaluations required by this section. The written opinion shall be
limited to the following information:
1. The employee's TB test status
2. The employee's infectivity status
3. A statement that the employee has been informed of the results of the
medical evaluation
4. A statement that the employee has been told about any medical
conditions resulting from exposure to TB that requires further evaluation
or treatment
5. Recommendations for medical removal or work restrictions and the
physician's opinion regarding the employee's ability to wear a respirator
B. All other findings or diagnoses shall remain confidential and shall not be
included in the written report.
IX. TRAINING
Ongoing annual education regarding airborne infectious diseases will be provided
to staff and offenders as part of the health education program. All employees
subject to occupational exposure shall receive training on airborne infectious
diseases at the time of initial assignment, and annually thereafter. The Training
Unit shall be responsible to ensure the training is in compliance with OSHA's
standards.
X. RECORDKEEPING
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: RESPIRATORY PROTECTIVE EQUIPMENT NO: G-170
FILE: TB PROTECTIVE EQUIPMENT
All medical screening, fit testing and training records shall be maintained in each
employee's personnel and training records in compliance with OSHA's standards.
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