Evaluate the effectiveness of current engineering and administrative strategies to eliminate or reduce exposure, as needed. Review occupational health records, morbidity and mortality data, and research findings to identify respiratory risk factors. Analyze the data to determine if potential hazards are present. Develop and recommend methods of eliminating or reducing hazards. Provide ongoing support and assessments to determine program effectiveness. Provide medical monitoring as required by regulations. Refer abnormal surveillance results and exposures above permissible levels to the company health care provider for evaluation and treatment. Nursing Roles The OHN provides both an administrative and clinical role in respiratory protection. The nurse collaborates with other disciplines to identify exposures and to implement an effective respira- tory program to reduce or prevent exposures. The nurse often is involved with respirator selec- tion and fit testing and conducting employee respirator education programs. Employee health monitoring should be conducted as mandated by regulations and company policy, and individ- ual and aggregate data should be analyzed for early identification of trends so as to implement effective corrective strategies. The OHN should seek the necessary continuing education pro- grams to maintain current information regarding respiratory protection programs. Administrative Role Develop and revise, or assist with the development of, effective policies and procedures. Establish effective protocols and resources to support the program. Plan, implement, and evaluate respiratory education programs based on exposures and regu- latory requirements. Manage the PPE program when necessary. Review current work guidelines for respiratory protection and revise them accordingly. Maintain complete and accurate records. Promote communication among the disciplines and communicate program status to management. Follow-up and evaluate employee compliance with controls or use of respiratory protection equipment. Clinical Role Establish baseline health assessment and periodic health monitoring and surveillance. Administer and review the required respirator medical questionnaire for respirator clearance. Update health status annually for continued clearance for respirator use. Evaluate health status data and determine if any work restrictions are advisable. Refer for fur- ther medical evaluation as needed. Collaborate on appropriate job placement and ability to wear personal respiratory protective equipment that might be required. Conduct respirator fit tests to ensure full protection. Obtain periodic subjective and objective information as components of ongoing health sur- veillance to detect early stages of diseases and implement corrective measures. Data can include a health history, medical examination, biological tests, and pulmonary function test- ing. Provide employee with written resource materials and information regarding community resources (e.g., American Lung Association) pertaining to respiratory health. 289
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