Respiratory Protection Program for School Nurses

By Tony Sharrock posted 10-26-2020 01:05 PM


 This article was provided by Brad Hunt, Chief Operating Officer, PRA Global.

In the time of COVID-19, school districts everywhere are asking themselves how to ensure the health and safety of their employees and how to comply with the law. More often with the novel coronavirus, school administrators and school boards are unsure which standards are applicable to this new threat. To assist schools with making decisions about a safe reopening, the Ohio Department of Health and Ohio Department of Education issued COVID-19 Health and Prevention Guidance for Ohio K-12 Schools

It provides extensive information, however, one item, in particular, requires additional explanation. Because school nurses care directly for students exhibiting symptoms of COVID-19, and thus, have a foreseeable risk, the school is required to provide appropriate personal protective equipment for their nurses: 

“School nurses or staff who care for individuals with symptoms must use appropriate personal protective equipment (PPE), provided by the school, in accordance with OSHA standards.”  --p.13

Though Ohio schools are not governed by the Occupational Health and Safety Administration (OHSA), they are regulated by the Public Employer Risk Reduction Program (PERRP), which has adopted many of OHSA’s standards as their own. You may be unaware of the many ways in which your school district interacts with PERRP. PERRP is responsible for conducting inspections of public employers, such as schools, and enforces health and safety codes. Public employers must also submit Injury and Illness logs to PERRP on an annual basis.   

PERRP directs employers to follow relevant sections of the Ohio Administrative Code (OAC), and under OAC section 4167-6-10, when an employee contracts COVID-19 from a work-related exposure and is hospitalized or dies, it is required to be reported to PERRP:

OAC 4167-6-10 - Reporting fatalities, hospitalization, amputations, and loss of an eye as a result of work-related incidents and hospitalizations requires public employers to orally report to PERRP work-related deaths within 8 hours and work-related hospitalization within 24 hours. 

That reporting may then trigger a PERRP inspection of the school facility, and the inspector will be asking questions about your preparedness programs such as “Where’s your PPE program for your school nurse?” This may well be a school’s first interaction with PERRP and it’s important to be ready. Have you implemented proper PPE for your nurses?  Having plans already in place will not only prevent staff hospitalizations and deaths but will save school districts money and headaches in the long run.

A school nurse’s job has a recognizable risk of occupational exposure, meaning the employer requires the employee to be exposed to someone with COVID in the course of their work. Because of this, employers are required to provide appropriate PPE. Failure to do so can lead, not only to illness, hospitalization, or death, but, in the case of a resulting inspection, to fines, premium increases, and workers' compensation claims. It’s best to be proactive. When an employee's hospitalization or death is reported to PERRP and results in an inspection, the inspector will no doubt investigate your programs, and what they find there has the possibility to hit hard in a school district’s pocketbook.

The U.S. Department of Labor has provided guidance for employers in determining work-relatedness. Coronavirus cases are generally considered work-related if: 

  1. The case is a confirmed case of COVID-19, as defined by the CDC
  2. An event or exposure in the work environment either caused or contributed to the resulting condition
  3. The case involves one or more of the general recording criteria: death, days away from work, job restriction, medical treatment, loss of consciousness, or a significant injury or illness diagnosed by a physician.

Under the OAC 4167-3-01 - Adoption of Federal Standards, health and safety standards disseminated by the U.S. Secretary of Labor including OSHA’s General Industry (1910) standards are implemented by PERRP. As a result, Ohio K-12 Schools employing school nurses are responsible for following applicable PERRP requirements, including OSHA's Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132), and Respiratory Protection (29 CFR 1910.134) standards.

Some of the requirements for each of these standards, as they pertain to schools, are listed below, though this list is not exhaustive. Schools are encouraged to determine if these requirements are being met to ensure compliance with PERRP standards.  Failure to meet these standards could result in fines, citations, and inspections. Work-related Coronavirus cases can be approved workers' compensation claims and will hit your policy and impact your premium and group rating status. If you have a nurse or healthcare worker in your school, it’s recommended that you follow these standards.

Bloodborne Pathogens

  • Each employer having an employee with occupational exposure (reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties) shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.
  • Engineering and work practice controls shall be used to eliminate or minimize employee exposure. If occupational exposure remains after the institution of these controls, personal protective equipment shall also be used.
  • Contaminated sharps shall be discarded immediately or as soon as feasible in appropriate containers.
  • Employees must receive training regarding the employer’s Exposure Control Plan.
  • The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.


Personal Protective Equipment

  • Protective equipment, including for eyes, face, head, and extremities, protective clothing, respiratory devices, and protective shields and barriers, shall be provided, used, and maintained in a sanitary and reliable condition wherever it is necessary by reason of hazards capable of causing injury or impairment in the function of any part of the body through absorption, inhalation or physical contact.
  • The employer shall assess the workplace to determine if hazards are present, or are likely to be present, which necessitate the use of personal protective equipment (PPE). If such hazards are present, or likely to be present, the employer shall:
    • Select, and have each affected employee use, the types of PPE that will protect the affected employee from the hazards identified in the hazard assessment
    • Communicate selection decisions to each affected employee
    • Select PPE that properly fits each affected employee
  • The employer shall verify that the required workplace hazard assessment has been performed through a written certification that identifies the workplace evaluated; the person certifying that the evaluation has been performed; the date(s) of the hazard assessment; and, which identifies the document as a certification of hazard assessment.
  • The employer shall provide training to each employee who is required to use PPE.
  • PPE shall be provided at no cost to the employee.


Respiratory Protection

  • A “face covering” is not a “respirator.” An N95 is defined as a “respirator.” This code applies when employees are “required” to wear respirators as part of their job duties to protect against respiratory hazards such as a school nurse potentially exposed to coronavirus.
  • In any workplace where respirators are necessary, the employer shall establish and implement a written respiratory protection program with worksite-specific procedures. The program shall be updated as necessary to reflect those changes in workplace conditions that affect respirator use. The employer shall include in the program the following provisions of this section, as applicable:
    • Procedures for selecting respirators for use in the workplace
    • Medical evaluations conducted by a physician or licensed health care professional for employees required to use respirators – before initial respirator use
    • Fit testing procedures to ensure tight-fitting respirators
    • Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations
    • Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators
    • Procedures to ensure adequate air quality, quantity, and flow of breathing air
    • Training of employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations
    • Training of employees in the proper use of respirators, including putting on and removing them, any limitations on their use, and their maintenance
    • Procedures for regularly evaluating the effectiveness of the program