As we continue our ongoing VelocityEHS Blog series on OSHA’s Top 10 Most Frequently Cited Standards in 2023, we come to number seven, down form number four in 2022, on the list, the Respiratory Protection Standard. The US Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety and Health (NIOSH) estimates that in 2020, more than 5 million US workers are required to wear respiratory protection as part of their regular work duties. Respirators are often the last and only line of defense between workers and exposure to potentially lethal respiratory hazards, making proper respiratory protection a literal matter of life and death for millions of workers. It’s no wonder why OSHA takes such a serious stance toward compliance and enforcement of the Respiratory Protection Standard.
Here, we’ll take a closer look at OSHA’s Respiratory Protection Standard, including the most commonly cited provisions of the Standard, key enforcement initiatives and directives you should have on your radar, and best practices and tools you can use to simplify and strengthen compliance.
OSHA’s Respiratory Protection Standard: A Persistent Compliance Challenge for Employers
As a quick recap of OSHA’s Top 10 Most Frequently Cited Standards for FY 2023:
- Fall Protection – General Requirements (1926.501): 7,271 violations
- Hazard Communication (1910.1200): 3,213 violations
- Ladders (1926.1053): 2,978 violations
- Scaffolding (1926.451): 2,859 violations
- Powered Industrial Trucks (1910.178): 2,561 violations
- Lockout/Tagout (1910.147): 2,554 violations
- Respiratory Protection (1910.134): 2,481 violations
- Fall Protection – Training Requirements (1926.503): 2,112 violations
- Personal Protective and Lifesaving Equipment – Eye and Face Protection (1926.102): 2,074 violations
- Machine Guarding (1910.212): 1,644 violations
As we mentioned in the first installment of our blog series, OSHA’s Fall Protection Standard was, by far, the most frequently cited OSHA standard in 2023. Coming in at number seven, the Respiratory Protection Standard may have dropped on the list but there was still a 3% increase in citations issued in 2023 up from 2,412 in 2022.
When we look at how frequently OSHA’s Respiratory Protection Standard was cited in 2023, as well as in 2020, 2021, and 2022, one conclusion we might make is that many of these violations were related to workplace requirements for use of N95 respirators and other respiratory protection during the COVID-19 pandemic. N95 masks are classified as a tight-fitting facepiece respirator under OSHA’s Respiratory Protection Standard, meaning employers must comply with requirements for respirator use under the Standard. With virtually every worker in every US workplace required to wear an N95 or equivalent respirator during the COVID-19 pandemic, you can imagine how citations under the Standard could skyrocket.
This makes sense if we look at recent data for recordable workplace injury and illness cases caused by exposure to harmful substances or environments. The National Safety Council (NSC) notes in its 2020 Injury Facts report that the number of recordable non-fatal injuries and illnesses due to exposure to harmful substances or environments rose from an average of around 40,000 cases per year between 2011-2019, to 424,360 cases in 2020. (Figure 1) This is more than a 1000% increase in recordable non-fatal injury and illness cases due to exposure to harmful substances or environments, making it the single most common cause of workplace injuries and illnesses that year. (Figure 2) When we break down the causes of these cases even further, NSC’s 2020 Injury Facts report shows that nearly 92% of all workplace illness cases with days away were attributed to COVID-19 (Figure 3).
Figure 1: NSC Injury Facts 2020
Figure 2: NSC 2020 Top Workplace Injuries & Illnesses by Type
Figure 3: Harmful Exposure Injuries & Illnesses by Nature, Part of Body, and Industry
However, if we look even further back in time at OSHA’s Top 10 Most Frequently Cited Standards, we can see that the Respiratory Protection Standard has consistently ranked on the Top 10 list since at least 2018, well before the beginning of the COVID-19 pandemic.
- 2023: Respiratory Protection: 2,481 violations
- 2022: Respiratory Protection: 2,430 violations
- 2021: Respiratory Protection: 2,527 violations
- 2020: Respiratory Protection: 2,649 violations
- 2019: Respiratory Protection: 2,450 violations
- 2018: Respiratory Protection: 3,118 violations
This enforcement trend is a clear signal that OSHA maintains a long-standing focus on respiratory protection and Respiratory Protection Standard compliance and will continue to maintain that focus for the foreseeable future, regardless of COVID-19 workplace respiratory protection requirements.
Analyzing OSHA’s Most Cited Respiratory Protection Standard Provisions
Of the 2,481 violations cited under OSHA’s Respiratory Protection Standard in 2023, here are the five most commonly cited provisions of the Standard:
- 1910.134(e)(1): “The employer shall provide a medical evaluation to determine the employee’s ability to use a respirator, before the employee is fit-tested or required to use the respirator in the workplace. The employer may discontinue an employee’s medical evaluations when the employee is no longer required to use a respirator.” –505 violations
- 1910.134(f)(2): “The employer shall ensure an employee using a tight-fitting facepiece respirator is fit-tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter.” –359 violations
- 1910.134(c)(1): “In any workplace where respirators are necessary to protect the health of the employee or whenever respirators are required by the employer, 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.” –358 violations
- 1910.134(c)(2): “Where respirator use is not required[…]” –244 violations
- 1910.134(f)(1): “The employer shall ensure employees using a tight-fitting facepiece respirator pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.” –132 violations
The Costs of Non-Compliance
Penalties for violations of OSHA’s Respiratory Protection Standard (and all OSHA Standards) can quickly pile up, with a single inspection or workplace injury often resulting in multiple citations. That’s because in addition to OSHA’s continuing focus on respiratory hazards and strong enforcement of Respiratory Protection Standard requirements, OSHA announced earlier this year that it would expand the application of “Instance by Instance” (IBI) citations.
Since 1990, OSHA has applied its IBI citation policy in scenarios where an inspection revealed multiple violations of an individual OSHA Standard provision. When applying the IBI policy, OSHA issues separate citations and penalties for each instance of non-compliance, rather than a single citation for multiple violations. Until earlier this year, OSHA only applied the IBI citation policy in cases where violations were found to be ‘willful’ in nature. That is no longer the case. As of January 2023, OSHA Regional Administrators and Area Directors have been granted discretion to apply the IBI citation policy in cases where one or more of the following factors are involved:
- The employer has received a willful, repeat, or failure to abate violation within the past five years where that classification is current
- The employer has failed to report a fatality, inpatient hospitalization, amputation, or loss of an eye pursuant to the requirements of 29 CFR 1904.39
- The proposed citations are related to a fatality/catastrophe
- The proposed recordkeeping citations are related to injury or illness(es) that occurred as a result of a serious hazard
Employers should also be conscious of the fact that federal civil penalties for non-compliance with federal regulations have gone up in 2023…way up. In January, OSHA published their 2023 annual civil penalty adjustments as required under the Federal Civil Penalties Inflation Adjustment Act of 2015. Under the Act, all federal agencies are required to revise and publish their schedule of civil penalties based on the previous year’s rate of inflation, which is calculated based on the US Bureau of Labor Statistics Consumer Price Index for all Urban Consumers (CPI-U). 2023 federal civil penalty adjustments are based on a published Consumer Price Index (CPI-U) multiplier of 1.07745.In other words, all federal fines and penalties for non-compliance went up by 7.7% — roughly equal to the average rate of inflation faced by all consumers in the US during 2022.
Respiratory Protection Injury & Illness Statistics: The Human Costs
The financial penalties for non-compliance with OSHA’s Respiratory Protection Standard can certainly damage your business’ bottom line, as well as its reputation in the eyes of customers, partners, investors, and other stakeholders. Sadly, it’s all too easy to overlook the cost to your business’ most important resource…your workers. An injury or illness due to missing or improper respiratory protection can be life-altering, even life ending.
The monetary costs of these injuries are difficult to quantify, but OSHA’s Safety Pays calculator allows us to calculate estimated costs of a wide range of occupational injury and illness types. For example, a respiratory disorder resulting from exposure to gases, fumes, chemicals, or other respiratory hazards is estimated to have direct costs of $41,013 and indirect costs of $45,114 for a total of $86,127. That’s quite a lot, and this estimate does little to account for the ongoing costs resulting from chronic health effects of exposure to respiratory hazards.
In fact, the Journal of American Medicine (JAMA) and CDC reported in 2020 that annual expenditures for workplace respiratory disorders among US workers totaled $7 billion for asthma care and $5 billion for chronic obstructive pulmonary disease (COPD). The study also noted that workplace exposures to respiratory hazards contribute to an estimated 44% of asthma cases and half (50%) of COPD cases among US workers.
Available data also suggests that the number and rate of chronic occupational illnesses and associated deaths due to respiratory exposures is far greater than most of us would even imagine. For example, BLS and NSC data shows that in 2021 there were 5,190 work-related fatalities. Now compare this to data from CDC and NIOSH which estimates that occupational disease is responsible for between 26,000 and 72,000 deaths in the United States every year.
Here are some additional chronic occupational illness statistics:
- Estimates published by the International Labor Organization (ILO) have found that exposure to hazardous substances claims the lives of almost 1 million workers annually. This translates to at least one worker dying every 30 seconds due to occupational chemical exposure.
- Cancer is the main cause of work-related death, and more than 200 different substances have been identified as known or probable human carcinogens, with many of these exposures occurring in the workplace.
- ILO data shows in the EU alone, occupational cancer was responsible for 102,500 deaths in 2011 and 106,300 in 2015, and occupational cancer now represents one of the primary causes of work-related deaths globally.
Respiratory Protection Best Practices
If we look at the numbers, we find that the five most common citations under OSHA’s Respiratory Protection Standard account for close to two-thirds (64%) of all violations of the Standard in 2023. That leaves nearly a third of all citations, more than 800 violations, that were issued for other provisions of the Standard not listed above. This tells me that US employers continue to struggle with a wide range of Respiratory Protection Standard requirements.
However, OSHA’s enforcement data allows us to draw some general assumptions about what provisions of the OSHA Respiratory Protection Standard employers should focus on to help strengthen the compliance of their own respiratory protection programs. The biggest areas of concern relate to the initial assessment and documentation of workers’ fitness for use of respirators and respiratory fit testing, and the development and documentation of formal workplace respiratory protection programs.
Medical Evaluation & Respirator Fit Testing (RFT)
The two most common provisions cited under the OSHA Respiratory Protection Standard have much to do with ensuring workers are sufficiently fit and capable to use respirators, and ensuring proper selection and fitting of respirators for workers who require them.
Employers must ensure that prior to requiring workers to use respirators, those workers are in a good condition of health and physical fitness to use them. If workers do not meet specific standards of health and fitness, they must not be placed into job roles that require respirator use. Under section 1910.134(e)(1) of OSHA’s Respiratory Protection Standard, employers must “provide a medical evaluation to determine the employee’s ability to use a respirator before the employee is fit tested or required to use the respirator in the workplace.”
This medical evaluation must be performed by a physician or other licensed health care professional (PLHCP) who shall apply the evaluation criteria listed in Appendix C of the Respiratory Protection Standard. Following the evaluation, the employer must obtain and retain a written recommendation regarding the employee’s ability to use the respirator from the PLHCP. The recommendation shall provide the following information:
- Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator
- The need, if any, for follow-up medical evaluations based on employee responses to the medical evaluation questionnaire
- A statement that the PLHCP has provided the employee with a copy of the PLHCP’s written recommendation
If a PLHCP provides a positive medical recommendation indicating a worker is fit to wear a respirator, you then need to ensure that workers are properly fitted for the size and type of respirators they will be using. Under Respiratory Protection Standard, OSHA requires the use of specific respirator fit testing (RFT) methods and procedures based on the type of respirator in question. Generally, these testing methods and procedures can be classified as either quantitative (QNFT) or qualitative (QLFT). QLFT test methods tend to be less technically complex than QNFT methods, but both are quite procedurally complex. Nonetheless, these RFT methods must be applied precisely to ensure compliance and safeguard worker health.
As far as when and how often to perform RFT, employers must ensure that employees using tight-fitting facepiece respirators are fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter. In addition, employers must perform subsequent RFT whenever “the employee reports, or the employer, PLHCP, supervisor, or program administrator makes visual observations of changes in the employee’s physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.” All RFT activities and results must be documented and retained at least until the next fit test is performed, but as a best practice, they should retained indefinitely as OSHA’s Respiratory Protection Standard requires that all “written materials required to be retained under this paragraph shall be made available upon request to affected employees and to the Assistant Secretary or designee for examination and copying.”
Employers should consider implementing a software system that coordinates the scheduling, documentation and follow up of your required medical evaluation and fit testing protocols and activities. This is particularly true for employers who need to manage fit testing compliance across multiple locations, or for large numbers of employees who use respirators in the workplace. If you can quickly and easily determine which employees use which types of respirators, what fit testing protocols are required for those respirator types, when fit tests must be performed, and then collect and document fit test results within a single software system, you’ll be well on your way to ensuring compliance with fit testing requirements.
Respiratory Protection Program Documentation
The other major category that Respiratory Protection Standard citations fall into would be failure to develop, document, and maintain a written respiratory protection program. Specifically, the failure to meet requirements under 1910.134(c)(1) that lay out what information what must be included in the written respiratory protection program, and failure to maintain a written respiratory protection program when respirator use by workers is voluntary, but not strictly required, as defined in 1910.134(c)(2). Let’s take a closer look at these two provisions to see how we can improve compliance.
To meet the requirements for written respiratory protection programs laid out in the OSHA Respiratory Protection Standard at 1910.134(c)(1), your written program must include the following information:
- Procedures for selecting respirators for use in the workplace
- Medical evaluations of employees required to use respirators
- Fit testing procedures for 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 for atmosphere-supplying respirators
- 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 respiratory protection program
Section 1910.134(c)(2) of the Respiratory Protection Standard concerns the development and maintenance of written respiratory protection programs where respirator use by workers is voluntary, but not strictly required. Employers may provide respirators at the request of employees or permit employees to use their own respirators. If the employer determines that any voluntary respirator use is permissible, the employer essentially assumes all the requirements under the Respiratory Protection Standard for workplaces where respirator use is mandatory, including developing and implementing all the elements of a written respiratory protection program noted above. Additionally, employers must provide those employees with the information contained in Appendix D of the Respiratory Protection Standard “Information for Employees Using Respirators When Not Required Under the Standard”, and they must provide respirators, training, and medical evaluations at no cost to the employee, even where respirator use is voluntary.
The requirements at 1910.134(c)(2) can place an additional burden on employers that they might not necessarily anticipate, so it’s understandable why some struggle with compliance. Again, employers should consider implementing a purpose-built software system that is capable of documenting and communicating respiratory protection program information, tracking respirator use (users, types, locations, RFT results, medical evaluations, etc.,) and performing all the various respiratory program compliance tasks within a single, centralized system.
Next in our series…
Follow us on LinkedIn and stay tuned to the VelocityEHS Blog for the next installment of our series on OSHA’s Top 10 Most Frequently Cited Standards in 2023 where we’ll take a look at #8 on the list, OSHA’s Fall Protection—Training Requirements.
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To see for yourself how Velocity can simplify compliance and strengthen workplace respiratory protection, Request a Demo today.