During the COVID-19 outbreak, the Centers for Disease Control and Prevention (CDC) has issued specific guidelines for personal protective equipment (PPE) to help ensure health care worker protection, such as gloves, gowns, face shields, and surgical masks or even respirators for high-risk exposures when aerosol generating procedures are possible.

PPE comes in many different types, shapes, sizes, and it can often be confusing to determine what protection is most appropriate for each individual and scenario. Thus, training and understanding of PPE is extremely important. In particular, respiratory protection is frequently misunderstood and requires very specific training and fit testing in order to protect a health care professional properly.

During any given year, between 1,200 and 1,300 UTHealth community members are typically fit tested and trained on respiratory protection to wear in health care settings. In 2020 so far, the UTHealth Office of Safety, Health, Environment, and Risk Management (SHERM) has exceeded its yearly average by mid-March.

“We have been operating the respiratory fit testing program virtually nonstop to meet the steep influx of clinical staff requiring fit testing and training for respiratory protection, and particularly N95 respirators,” said Scott Patlovich, DrPH, assistant vice president of environmental health and safety. “In addition to hosting routine surge capacity large group fit testing sessions, we have frequent walk-ins coming to our office and an extremely high volume of people calling to ask questions to determine their specific and unique personal protective equipment needs. Our staff has been working tirelessly to take care of our health care workers during this unprecedented event.”

To be able to safely wear respiratory protection at work, employees must first be medically cleared to wear a respirator – a process overseen by the Occupational Health Program within UT Health Services. This medical clearance process involves a questionnaire to ensure the individual is medically fit to wear respiratory protection and there are no underlying health conditions that may prevent the person from safely wearing the respirator. Respirators are not necessarily easy or comfortable to wear, and they put resistance on normal breathing, so this medical clearance is very important. Then, health care workers must be fit tested, per OSHA regulations. With the increase in demand for this service, the two groups are working in tandem. SHERM has repurposed staff from various programs within the department to assist with the increased demand for fit testing and training, and they have also enlisted the help of volunteers from the UTHealth School of Public Health Student Epidemic Intelligence Society to assist with administering the fit tests and training.

SHERM also has identified a stockpile of half-face elastomeric respirators, which are left over from supplies obtained during Hurricane Harvey in 2017. These respirators are designed to be used in industrial settings to protect against inhaling dust particles or hazardous chemicals, but based on N95 supply shortages, these masks have been repurposed for use by health care workers with the highest risk of exposure to aerosol-generating procedures. They are reusable as long as they are properly decontaminated by thoroughly wiping down with EPA-registered disinfectant wipes. SHERM has developed detailed training and disinfection protocols for these respirators to be safely used in clinical settings.

“We are working in tandem with Occupational Health to be as efficient as possible in our efforts to train and fit test as many people as possible during this pandemic,” Patlovich said.

SHERM team members have been conducting a variety of other tasks to assist with the COVID-19 situation, including serving on the Procurement Task Force to help source much needed PPE for clinics, providing training on proper cleaning and disinfection protocols for our buildings, and organizing and hosting daily emergency management phone calls with UTHealth leadership and clinical management.