Respiratory protective devices: Rates of medical clearance and causes for work restrictions

Abstract

Background There are no published data on the outcomes and benefits of medical evaluations for the use of respiratory protective devices. We, therefore, conducted a retrospective database and chart review to assess the rates of medical clearance and causes for work restrictions at a Department of Energy complex. Methods All workers with work restrictions or denied clearance over a one‐year period were identified and their medical records abstracted. Results Of the 5,569 workers who received medical evaluation, only 71 (1.3%) received limitations on respirator use documented in their medical record. Of the 65 workers with sufficient medical records for additional analysis, 9 of the 5,569 workers (0.2%) were denied medical clearance, while 56 workers (1.1%) received work restrictions. Pregnancy was the most common cause for denying medical clearance for respirator use. Lung disease, cardiovascular disease, and claustrophobia were the most common causes for work restrictions. Physical examination and spirometry added little to the detection of relevant medical conditions. Conclusions We conclude that few workers fail medical clearance for respirator use or receive work restrictions. Data on adverse events from respirator use are needed to help design appropriate medical evaluations and uniform criteria for work restrictions or denial of medical clearance. Am. J. Ind. Med. 35:390–394, 1999. © 1999 Wiley‐Liss, Inc.

Modeling the cost–benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome

“…(28) The use of spirometry and physical examination were found to add little to the detection of relevant medical conditions for clearance to use a respirator. (29) Although screening for musculoskeletal disorders is advocated as a way to reduce workers' compensation costs (30), existing screening policies are rarely based on data showing appropriate diagnostic yield or cost-benefit. In a systematic review of assessment for fitness for work, Serra (31) found general confusion about the decision-making process used to judge fitness for work, and very scarce scientific evidence based on empirical data to support current practices.…”

Reproductive and Developmental Hazard Management Guidance

“…When personal protective equipment may be required to control exposure, temporary reassignment should be considered in most of the above scenarios if there is a significant exposure to a known reproductive hazard because PPE may not offer perfect protection and because there are limited data on respirator use during pregnancy. 35 Temporary reassignment should also be considered when an individual's medical history or risk factors suggest a need.…”

Physiological Burden Associated with the Use of Filtering Facepiece Respirators (N95 Masks) during Pregnancy

“…71 From a U.S. regulatory perspective, the OSHA CFR 1910.124 regulation governing respiratory protection in the workplace does not ask about pregnancy in its mandatory medical questionnaire. 11 Leakage into the breathing zone while wearing an N95 FFR can occur (1) through the filter media itself, (2) at the face=N95 FFR interface, and (3) from other components of the respirator (e.g., exhalation valve); the combined leakage is termed total inward leakage. 72 Optimal protection from an N95 FFR requires that the respirator selected fits the wearer appropriately so as to minimize leakage at the face=N95 FFR interface.…”

“…9 However, there is little reliable information or guidance regarding the use of FFRs during pregnancy. 7,10,11 Further, there are numerous inconsistent or contradictory statements about this topic. For example, a Canadian worker safety guideline 12 from the province of Alberta's Department of Employment, Immigration, and Industry stipulates that ''pregnant workers with lower than normal pulmonary function should be carefully assessed as to their fitness to use respirators because of concerns that the diaphragmatic elevation during pregnancy and the increased oxygen demand of pregnancy produce a trend toward the likelihood of respiratory fatigue while wearing some respirators,'' 12 whereas another guideline 13 from the same agency, addressing the medical assessment of respirator users, does not mention pregnancy.…”