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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. Page 1 of 7 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. Page 2 of 7 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. Page 3 of 7 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. Page 4 of 7 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. Page 5 of 7 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 Page 6 of 7 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. Page 7 of 7