Pulmonary function testing and respirator medical programs

June 17, 1993
Steve Trawick, Director
Occupational Safety and Health
United Paperworkers International Union
[Recipient address omitted]
Dear Mr. Trawick:
This is in response to your letter of February 18, concerning the Occupational Safety and Health Administration (OSHA) regulation 29 CFR 1910.134, "Respiratory Protection."
Your letter was in response to correspondence you received from Mr. Louis Givens of United Paperworkers International Union (UPIU) Local 360 in Collinston, Louisiana. He was concerned about the transmission of disease through the spirometer during pulmonary function testing and about the training requirements for persons administering the pulmonary function test (PFT). We will address your concerns in the order presented in your letter.
Mr. Givens first states that the respiratory protection standard requires a PFT for all employees using a respirator. This is incorrect; pulmonary function testing is only required in the medical surveillance provisions of specific OSHA standards, such as 29 CFR 1910.1001, Asbestos; 29 CFR 1910.1043, Cotton Dust; 29 CFR 1910.1028, Benzene; and 29 CFR 1910.1048, Formaldehyde. These standards require that the employer provide medical surveillance examinations to certain employees. The standards do not make employee participation in medical surveillance programs mandatory. The respiratory protection standard, at [29 CFR 1910.134(c)(1)(ii), paragraph 1910.134(e)], requires that a physician determine the health and physical conditions necessary for an employee in order to physically perform the work while wearing a respirator. It further encourages employers to assign employees tasks requiring respirator use when they are physically able to perform the task while using the equipment. However, it does not make mandatory the administration of a particular evaluation procedure, such as the PFT.
Mr. Givens also wrote that the bloodborne pathogens rule states "all body fluids shall be considered potentially infectious materials." This is also incorrect; the standard lists the body fluids other than blood which are considered "other potentially infectious materials" (OPIM), and saliva is only considered OPIM when present in a dental procedure or when it is visibly contaminated with blood (see 29 CFR 1910.1030(a)). Therefore, the moisture left in the spirometer after a PFT would not transmit a bloodborne pathogen to the next employee being tested, nor would it represent exposure as defined by the standard.
You then asked with regard to tuberculosis and other infectious diseases, "What steps should the company take to ensure that diseases are not transmitted during pulmonary function testing?" Although the Centers for Disease Control and Prevention (CDC) have received no reports of tuberculosis being transmitted via a spirometer, the Food and Drug Administration (FDA) says that a potential for transmission of tuberculosis does exist if the spirometer is not cleaned and filters are not used. New spirometers are equipped with filters, but there are still older machines in use which do not have filters.
One manufacturer states that their spirometers are to be used with disposable filters along with cold sterilization of the tubing and mouthpiece to prevent disease transmission. Since OSHA has no regulations regarding the cleaning of spirometers, you may wish to ask the testing company or the manufacturer of the equipment what procedures they recommend to prevent disease transmission. You may also wish to contact the CDC at [800-232-4636], or the American Thoracic Society at [212-315-8640] for their recommendations or any information about prevention of disease transmission.
Mr. Givens is correct that under the asbestos standard, 29 CFR 1910.1001(l)(1)(ii)(B), persons other than licensed physicians who administer PFT's are to complete a training course in spirometry sponsored by an appropriate academic or professional institution. The standard does not require that completion of this training course be documented or that the company grant access to any such documentation to employees. However, if employees believe that improperly-trained persons are administering PFT's, they should file complaints with the local OSHA Area Office. In investigating whether this provision of the standard has been violated, OSHA may, by subpoena, compel the production of any documents and testimony concerning the completion of a training course.
Your next question asked if persons administering the PFT for hazards not covered under the asbestos standard are also required to be trained. OSHA has no general standard to this effect. Specific training requirements for a PFT are included in specific vertical standards such as those for asbestos and cotton dust. OSHA would, of course, encourage all testers to be appropriately trained.
We hope this has been responsive to your concerns. Thank you for your interest in employee safety and health.
Sincerely,
Roger A. Clark, Director
Directorate of Compliance Programs
[Corrected April 1, 2009]