The 2009 H1N1 influenza outbreak identified the need for respiratory protection programs in New York State's 639 nursing home facilities. CDC's October 14, 2009, "Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, including Protection of Healthcare Personnel" determined that long-term care facilities would need to use respiratory protection to comply with the OSHA standard. Although the New York State Department of Health (NYSDOH) has no enforcement powers regarding OSHA regulations, it provided training on implementing the hierarchy of controls and developing a respiratory protection program.
The major components of a respiratory protection program include: development of a written respiratory protection plan, medical evaluations for employees who may need respiratory protection, employee training, fit testing, and the necessary recordkeeping. Until the emergence of the 2009 H1N1 virus, most of the nursing home facilities did not require respiratory protection, since residents ill with tuberculosis or other infectious airborne agents were sent to acute care facilities.
To expedite this process and reach the largest number of facilities in a short time period, NYSDOH developed a compliance program to assist nursing homes with the respiratory protection standard. The program contained a sample of a respiratory protection program that included comments from both an OSHA Area office and the Public Employees Safety and Health (PESH) program. Although these agencies do not formally approve sample programs, they were able to provide valuable input to ensure that the sample met the requirements of the respiratory protection standard.
NYSDOH had an existing relationship with eleven Occupational Health Clinics (OHCs) and determined that the OHCs would be the best source of hands-on technical assistance, fit-testing, and training for individual long-term care facilities. NYSDOH provided each OHC with CDC grant funds, and each of the 639 long-term care facilities was assigned to an OHC located within the region.
The compliance program contained the tools necessary to provide immediate training to long-term care facilities and included: a PowerPoint training for long-term care facilities; a list of supply vendors for N-95 respirators and fit-testing equipment; a link to CDC's October 14, 2009, guidance document; a list of New York State OHCs that were funded to assist the long-term care facilities; and a checklist of the OSHA standard (29 CFR 1910.134) to ensure that each nursing home followed all of the requirements.
A variety of methods to notify the facilities of the opportunity for assistance from the OHCs was undertaken. A "Dear Administrator" letter describing the compliance package and potential for OHC assistance was sent to each long-term care facility. As of early December 2009, three webinars, four conference calls, two professional association meetings, and one conference were held to describe the program. Each of these outreach efforts was extremely successful in generating interest from the facilities.
One barrier that schools faced as they tried to comply with the respiratory protection standard was the lack of access to N-95 respirators. NYSDOH evaluated the Strategic National Stockpile (SNS) allotments and found that large amounts of N-95s in the stockpile were NIOSH-approved but not cleared by the FDA. Since these respirators could not be used by acute care facilities, they could be supplied to long-term care facilities after a good faith effort to obtain respirators from the standard suppliers. Requests for these supplies were submitted to county emergency managers, who then helped to provide the needed equipment.
The collaborative effort between nursing home facilities, NYSDOH, the OHCs, and county emergency managers is ongoing. It has already proven to be effective for informing nursing home personnel about the respiratory protection standard, and it has helped to develop effective and sustainable partnerships between different groups.