Special Note: Overview of Respiratory Protection: Fit Testing Workshop - days: January 6, 2015 January 7-8, 2015. Respiratory Protection Newsletter from Dr. McKay November 2014 © 2014 All rights reserved, Roy McKay, Ph.D. What is the frequency of fit testing? OSHA addresses the frequency of respirator fit testing in paragraph (f), sections 2, 3, & 4 of the Respirator Standard 1910.134. In section (2) of the OSHA standard, it states the following requirements when tight fitting respirators are required to be worn: “You really can’t say you have a good fit testing program, if you haven’t evaluated it. This may be especially true when very high fit factors are common practice or when respirator wearer’s frequently change sizes and/or models.” Roy McKay, Ph.D. April 24, 2014. Presented at Fit Testing Refresher & Advanced Topics. (2) The employer shall ensure that 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. Additional information is provided in sections (3) & (4), where it states: (3) The employer shall conduct an additional fit test 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. (4) If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program administrator, supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall be given a reasonable opportunity to select a different respirator facepiece and to be retested. In essence, OSHA’s requirement is very straightforward. OSHA requires fit testing prior to using a tight fitting facepiece in areas that require protection from respiratory hazards. It is then repeated at least annually when respiratory protection is still required. In addition, a fit test should be conducted if a different (make, model, style, or size) facepiece is to be used. This just makes common sense. Sections 3 & 4 essentially state that the fit test should be repeated when the previously fitted facepiece no longer appears to fit. “The question is? Do you want a higher fit factor or do you want better respirator fit? They are not necessarily the same.” Roy McKay, Ph.D. February 28, 2014. Presented at the ERC Respiratory Protection in Health Care Environments. © 2014, All rights reserved, Roy McKay, Ph.D. Taking a training break in Dubai, United Arab Emirates, November 6, 2014. Reader Question: Do fit testing exercises affect some respirator models differently than others? Yes. Some respirators models are affected by head movement exercises more than others. For example, some respirators have strap and/or buckle designs that tend to loosen during the bending exercise, but affected to a lesser degree with other exercises. For these models, respirator leakage may not be detected if the fit testing protocol excludes the bending exercise, utilizes an exercise duration that is too short, or when the fit test operator doesn’t conscientiously watch the subject to ensure the exercise is properly conducted. When respirators having these characteristics are selected for use in the workplace, the fit test operator should make sure all exercises are properly performed and/or may need to supplement the exercise protocol with exercises known to Pg 1 of 8 challenge facepiece design. In other cases, respirators equipped with heavy canisters, communication devices, and/or other accessories, may cause straps to loosen. The time necessary to induce this leakage can vary considerably from one model to another and may be influenced by strap tension, strap design, buckle design and/or other design features. Experienced fit testers should be familiar with these issues and communicate this information to the respirator trainer, who will in turn incorporate this information into worker training programs. In summary, two respirator models having identical sealing surfaces, may respond to fit testing exercises differently depending upon strap and/or buckle design, material, wear & tear, and other factors. SCBA Buddy Breathing Acceptance NIOSH is revising its policy on the use of Emergency Breathing Support Systems (EBSS), also known as “Buddy Breathers”. This policy change will be applicable only to SCBAs meeting the requirements of NFPA 1981, 2013, or subsequent editions. NIOSH will recognize NFPA 1981, 2013compliant EBSS systems as a part of the NIOSH SCBA approval for users who have received the appropriate level of training. In a letter dated February 28, 2014 from Jonathan Szalajda (Acting Chief, Technical Evaluations Branch, NPPTL), this policy change was based upon a review of submissions made to the NIOSH Docket 147, as well as the applicable OSHA standards. NIOSH is therefore modifying the existing “Buddy Breather” policy to further support and encourage best practices in the fire service for the deployment of EBSS. Accessories available on some manufacturers’ products enable users to have the option to provide buddy breathing; however, effective training programs are not in place across the nation. NIOSH will require the manufacturer User Instructions to provide training information. The approval label must include these additional cautions and limitations. For example, EBSS Activation or engagement of EBSS in either the donor or receiver mode changes the SCBA use to Escape-Only, approved service time for either the donor, or the receiver is no longer applicable. Additional critical cautions and limitations apply. © 2014, All rights reserved, Roy McKay, Ph.D. For additional information visit the NIOSH web page at www.cdc.gov/niosh. Fit Testing Refresher & Advanced Topics This course is specifically designed for the person who has been conducting fit tests, but has not had formal training or needs a review. This course reviews OSHA fit testing requirements and also helps the operator understand why poorly fitting respirators pass fit testing and why good fitting respirators fail. Apr 29, 2015 Oct 27, 2015 Explaining Alphabet Soup for Closed Circuit Escape Respirators On July 24, 2014 NIOSH issued the first approval for a respirator that complies with their new requirements for Closed Circuit Escape Respirators (CCERs). Some of the new requirements include features to warn the users of changes to device performance or capability to withstand more rugged environments. In addition, the new certification process now utilizes a breathing simulator which is expected to provide a more reliable approach to evaluate the performance of these devices. Testing and certification requirements for these respirators were established by NIOSH in a new standard for CCERs published in 2012. Closed-Circuit Escape Respirators utilize compact technology to provide self-contained, breathable air to workers in emergencies, such as escape from a shipboard fire below deck or a smoke-filled mine from a mine fire. They are also used by workers involved in tunneling operations, certain construction operations, and for crew members on freight trains carrying hazardous materials. Their compact size allows them to be easily carried on a worker’s belt or stored in close proximity to be accessible in an emergency. The closed-circuit technology recirculates and replenishes the user’s breathing air making the most efficient use of the oxygen it contains. Oxygen is replenished from either a chemical reaction or from a compressed-oxygen supply and exhaled carbon dioxide is chemically removed. However, users may not readily understand or Pg 2 of 8 become confused with all of the abbreviations used to describe these respirators. Terminology often tends to differ depending upon where the respirator is used. With this in mind, let’s explore commonly used abbreviations for these respirators: CCER = Closed-Circuit Escape Respirator EEBD = Emergency Escape Breathing Device EEBA = Emergency Escape Breathing Apparatus SCSR = Self-Contained Self Rescuer CCER is the current abbreviation used by NIOSH for this class of respirators. EEBD & EEBA are abbreviations commonly used by the U.S. Navy and commercial shipping industries. SCSR is commonly used in the mining community. As a point of information, a NIOSH certified CCER is not necessarily permitted for mining applications. For example, the first NIOSH certified CCER as a “Cap I, 20 liter” is not certified for mining applications. NIOSH Respirator User Notice Feb 27, 2014 Readers of this newsletter commonly know that OSHA requires the use of respirators approved by NIOSH for occupational inhalation exposures when engineering or administrative controls are not adequate to reduce the hazards to an acceptable level. Furthermore, the use of a non NIOSHapproved respirator places the employer at risk of citation and fines by OSHA. The following paragraphs may therefore be of interest and were taken from a NIOSH User Notice with slight modification. NIOSH issues certificates of approval for specific and complete respirator assemblies. The approval is granted after the respirator has been evaluated and found to be in compliance with applicable regulations in Title 42, Code of Federal Regulations, Part 84. In the February 27, 2014 User Notice, NIOSH reports that they are once again becoming aware of a dangerous practice where respirator users are swapping the hoses provided with supplied-air respirators with those from another source. The concern NIOSH has when using non-original equipment are that size differences can result in too little or too much breathing air being delivered to the facepiece. In addition, because non-approved hoses have not been subjected to the rigors of the NIOSHapproved quality assurance program they may have © 2014, All rights reserved, Roy McKay, Ph.D. other performance features that are not compatible to the proper performance of the respirator. Remember, respirators and their various component parts, are approved as a single unit. Replacing NIOSH-approved respirator parts, components, and accessories with non NIOSH-approved parts manufactured by another company voids the NIOSH approval. This is because the level of performance achieved may no longer be sufficient. Therefore, the modified configuration puts the user at risk. Using a modified configuration may also void the manufacturer’s product warranty. For additional information, visit the NIOSH web site at www.cdc.gov/niosh Thoughts Regarding the Institute of Medicine’s Workshop on PAPR’s On August 7 & 8, 2014, the Institute of Medicine (IOM) held a workshop on respiratory protection for use in health care settings. The name of the workshop was: "The Use and Effectiveness of Powered Air-Purifying Respirators in Health Care". The workshop was open to the public and could be attended remotely (as I did). Some of the speakers were excellent. However, comments from other speakers raised concerns regarding their understanding of respiratory protection and PAPRs in particular. For example, several speakers make comments such as PAPRs require very little training. Other comments were that PAPRs require less training than N95 FFRs, etc. It some cases, it appeared that the emphasis for some hospital programs was how easy PAPR training could be. These comments raise concerns regarding the content of PAPR training programs in health care. Perhaps the bigger concern is not the content included, but the content excluded. An effective PAPR training program requires hands-on training. Hands-on training requires donning, doffing, inspection, and verification that the respirator wearer can properly conduct flow check procedures. Other components of a PAPR training program should include; assembly/installation of components, battery maintenance, and recognition of worn, damaged and/or missing components, safety issues, etc. This is particularly important when PAPR users share equipment with others. Industrial experience with PAPR users has shown us that PAPRs are not necessarily simple devices. While PAPRs have many advantages, proper use of a PAPR requires comprehensive training that goes well beyond checking airflow, how to turn on the blower, and being shown how to put it on. Of concern is whether Pg 3 of 8 or not PAPR trainers in health care facilities have adequate experience with PAPRs to train others. PAPRs are air purifying devices. In this respect, training includes many (if not most) of the same content of negative pressure air purifying respirators. Consequently, PAPR training includes components of negative pressure air purifying respirators as well as training on the powered air component itself. During the conference, One participant questioned the panel as to whether or not anyone has actually measured the effectiveness of their PAPR training methods, at which time there was a period of dead silence. One comment expressed by several participants was the recognition that many programs haven’t figured out how to clean and disinfect PAPRs after use. Some manufacturer instructions for cleaning and disinfection are vague. One speaker specifically mentioned that it would be helpful if user instructions included specific recommendations regarding cleaning agents that can be used. Another speaker mad ethe comment that PAPRs are not likely to replace N95 FFRs for all circumstances. The conference included discussion and comment on fit testing procedures used at some health care facilities to fit test N95 FFRs. Many were said to be deficient. I wonder if these deficient procedures would be used to fit test family members prior to entry into a potentially hazardous environment. It was obvious that some programs have serious problems with their fit testing programs. Some participants were unclear regarding the need for annual fit testing for tight fitting respirators. Others incorrectly believe that the primary reason for annual fit testing was to determine if there was a change in the shape of the face. During lunch and other breaks, the room microphones were left on. Consequently, some participants didn’t realize that their “private” conversations could be heard by others who dialed in remotely. During these times the true philosophy of respiratory protection became apparent. Spirometry Refresher: December 18, 2014 in Tampa, FL Apr 28, 2015 in Cincinnati Sept 22, 2015 in Cincinnati Interpretation of Spirometry: Beyond the Numbers September 23, 2015 in Cincinnati © 2014, All rights reserved, Roy McKay, Ph.D. Transmission of Infection on Commercial Airlines While returning from a training program in Dubai, I was thinking of safety concerns some people expressed for passengers and crew during commercial flights. With respect to Ebola, the majority of expert opinion suggests that direct patient contact is necessary for transmission. Airborne exposure is considered by most, as unlikely. Flight times from Dubai (which is not in West Africa) to the USA are at least 13 hours in duration. Halfway through my return flight, a lady just two seats away developed a productive cough with nasal and chest congestion. Initially, she was fine immediately after boarding the plane. Halfway through the flight she developed symptoms consistent with a respiratory infection. At one point I needed to use the restroom. When I attempted to wash my hands, the water barely trickled out of the faucet. In addition, it was difficult to depress the faucet handles located at the top of the sink, while simultaneously trying to position my hands under the faucet. Hand hygiene is not my area of expertise, but my hand-washing technique isn’t as good on commercial flights as it is at home or work. Trying to clean your hands is even worse, when the flow of water is just a trickle. All of this made me wonder. Has anyone ever evaluated the effectiveness of hand washing with airline sinks? Trends in Respiratory Protection for Healthcare Workers Do you remember a time when it was difficult, if not next to impossible to implement the use of N95 filtering facepiece respirators in healthcare? Now the trend appears to be toward the use of elastomeric half mask and powered air-purifying respirators (PAPRs). Comments from healthcare stakeholders in response to a recent NIOSH request for information regarding respirators used in healthcare indicate that this is a recent trend that is likely to continue. It was noted that PAPRs are becoming lighter in weight, easier to operate, and less expensive, which contributes to this trend. In other hospitals, elastomeric half mask respirators are being introduced as another alternative to N95 FFRs. Pg 4 of 8 Test Your Fit Testing Knowledge: Test your skill against these questions. Answer appears in “Training Opportunities” at the end of this newsletter. of respirator worn, work environment, duration of use, level of physical exertion, underlying medical conditions that contributed to the complication, etc., is needed. You can send this information to [email protected] Question: With regard to conducting qualitative fit testing with sweetener and/or bitter solutions, proper procedure during sensitivity screening is to direct the aerosol output from the nebulizer toward the nose and mouth? 9 True 9 False Question: With respect to donning a two-strap filtering facepiece respirator for persons with long hair that falls behind the head (i.e., such as a “pony tail”), the lower strap should be worn around the neck, below the ears and should be _________ the hair. a) under (i.e., touching the skin) b) over (i.e., not touching the skin) Onsite Training Programs During 2014 An abbreviated list of locations visited by Dr. McKay for on-site training programs during calendar year 2014 are: Dubai, United Arab Emirates Tampa, Florida Dayton, OH Louisville, KY Washington, DC Next stop: Budapest, Hungary Medical Complications from Respirator Use OSHA requires respirator medical clearance for persons required to wear respiratory protection. Researchers at the University of Cincinnati are collecting information on persons who: 1) developed a medical complication while wearing a respirator, and 2) identify medical conditions causally related to the complication that developed. If you have information (published or un-published) that established a link between a specific medical condition(s) and a complication that developed as a result from wearing a respirator, please share this information with us. We are particularly interested in cases where a medical complication was induced by respirator use. Information such as the specific type © 2014, All rights reserved, Roy McKay, Ph.D. Wanted: Damaged Fit Test Adapters Rather than throwing away damaged fit test adapters, consider donating them to our fit testing workshops. We strive to make our fit testing workshops as realistic as possible. In some cases, incorporating damaged fit testing adapters provide a valuable training experience. If you wish to make a donation, please email us at [email protected] 2014 McKay Publications Xinjian He, Tiina Reponen, Roy McKay & Sergey Grinshpun. How does breathing frequency affect the performance of an N95 filtering facepiece respirator and a surgical mask against surrogates of viral particles? Journal of Occupational & Environmental Hygiene 11: 178-185, 2014. He X, Grinshpun SA, Reponen T, McKay R, Bergman M, and Zhuang Z. Effect of Breathing Frequency and Flow Rate on the Total Inward Leakage of an Elastomeric Half-Mask Donned on an Advanced Manikin Headform. Annals of Occupational Hygiene 58:182-194, 2014. Share Your Respirator Experience Here’s an opportunity to contribute your knowledge and experience to others. If you have an interesting respirator selection or other challenging respirator problem (and solution), please submit it to [email protected]. I may use your real-life problem to help train students in our graduate and continuing education programs in respiratory Pg 5 of 8 protection. This transfer of information will benefit others, maybe even your children or grandchildren. Respirator Training Courses: The University of Cincinnati is pleased to announce the following programs on Respiratory Protection and Fit Testing that may be of interest to your staff. They are: Fit Testing Refresher & Advanced Topics http://www.drmckay.com/rtc-resp-refresher-advanced .shtml Apr 29, 2015 Oct 27, 2015 Overview of Respiratory Protection: http://www.drmckay.com/rtc-overview.shtml Jan 6, 2015 April 21, 2015 Oct 20, 2015 Fit Testing Workshop (2-day): http://www.drmckay.com/rtc-workshop.shtml Jan 7-8, 2015 Apr 22-23, 2015 Oct 21-22, 2015 Fit Testing Workshop Quantitative (1-day): http://www.drmckay.com/rtc-workshop1day.shtml Dates to Be Determined Respirator Selection & Cartridge Change Out Schedule Workshop. http://www.drmckay.com/rtc-resp_selection.shtml May 13 & 14, 2015 All courses are held in Cincinnati, unless noted otherwise. On-site training is available. Respirator Selection & Change Out Schedules This workshop provides guidance on respirator selection and the development of OSHA compliant change out schedules for respirator cartridges. A combination of lecture with practice problem sessions is used. The course is designed to teach students how to select a respirator based on workplace conditions (exposure level, type of contaminant, length of time to be worn, etc.). The selection process goes beyond the typical recommendation to "use a NIOSH approved air purifying respirator". Students will learn how to select a specific respirator as well as a specific filter/cartridge (when appropriate). More than a dozen guidelines for development of an OSHA compliant cartridge change out policy will also be taught, including common computer models and how to use them. © 2014, All rights reserved, Roy McKay, Ph.D. Partial Listing of Topics Respirator Selection * Review of facepiece definitions and modes of operation. * Practical and theoretical basis for respirator selection based upon: Assigned Protection Factors (APF) - MUC’s, HR’s, IDLH, etc. * OSHA guidelines for respirator selection. - IDLH and non-IDLH atmospheres. * Selection steps and information gathering procedures. * Minimum respiratory protection versus practical alternatives. * Filter selection issues - How to select an N, R, or P filter. - Why filter selection is influenced by exposures below the exposure limit. - How to choose a 95 versus 100 filter. * Practical methods for handling unknown concentrations without defaulting to an SCBA. * Calculating MUC’s for mixtures. * Saturated Vapor Concentrations (SVC’s) and selection concerns. * When a particulate filter may be needed for organic solvents. * Equilibrium Vapor Concentrations. * Selection Workshop - Practical problems and solutions. Development of Cartridge Change Out Schedules * OSHA recommendations for a change out policy. * Factors that affect cartridge service life. * Learn how to develop an OSHA compliant change out schedule. * Understanding the breakthrough curve. * Common methods used to define breakthrough. * What level of breakthrough should be used? * Work rate tables. * Effect of high relative humidity. * Methods for determining service life (use, limitations, and practice problems) - OSHA recommendations - Rules of thumb - Using laboratory data - Using math models - Using computer (software) models - Cartridge testing methods (3 methods) Combining methods * Learn how to develop a change schedule when computer models are not available. * Recommendations for mixtures: - OSHA compliance method - mole fraction method - multi vapor model Pg 6 of 8 * * * How to confirm your change-out schedule. Storage and migration concerns. Immediate Breakthrough Upon Reuse (IBUR) concepts Gain confidence that your current procedure is correct! Former students have found this information to be extremely valuable. Even experienced students find the material useful as a way to verify their current procedures. Next dates are: May13-14, 2015 in Cincinnati Answers to Test Your Fit Testing Knowledge: Question: With regard to conducting qualitative fit testing with sweetener and/or bitter solutions, proper procedure during sensitivity screening is to direct the aerosol output from the nebulizer toward the nose and mouth? Answer: False. This would be a violation of the respirator standard since it represents a modification of the OSHA fit testing protocol. Perhaps more importantly, modifying the procedure in this manner could fail to identify a poorly fitting respirator. Question: With respect to donning a two-strap filtering facepiece respirator for persons with long hair that falls behind the head (i.e., such as a “pony tail”), the lower strap should be worn around the neck, below the ears and should be _________ the hair. a) under (i.e., touching the skin) b) over (i.e., not touching the skin) Answer: a) under (i.e., touching the skin) Having the strap over the hair is inconsistent with the majority of manufacturer instructions and creates an opportunity for the hair to tug on the straps, potentially moving the facepiece. Overview of Respiratory Protection: This one day course provides a practical overview of respirators, standards, guidelines, use, and limitations of commonly used air purifying respirators. This class also provides an excellent overview of the OSHA Respirator Standard. Little or no prior formal training is required. The morning session includes lectures on the types and use of respirators and basic respirator selection procedures using APFs and MUCs. The advantages and disadvantages of © 2014, All rights reserved, Roy McKay, Ph.D. different respirator facepieces, filters (N, R, & P), cartridges, PAPR's, and the physiologic effects of wearing a respirator will also be discussed. Respirator standards and program requirements will be reviewed to help the student comply with OSHA regulations. Discussion of qualitative and quantitative fit testing, user seal checks, worker training, and respirator medical clearance requirements will be provided. This course is essential for individuals who oversee respirator users in their work place or new to respiratory protection. Fit Testing Workshop: This two (2) day workshop provides comprehensive lecture and "hands-on" training for students who need to learn how to conduct an OSHA accepted qualitative or quantitative respirator fit test. Students will have an opportunity to fit test a variety of different style facepieces, including filtering facepieces, half, & full. A combination of lecture and "hands-on" testing in the presence of a trained and experienced instructor will be used to help participants learn how to conduct respirator fit testing to satisfy regulatory requirements. Hands-on fit testing will include qualitative and quantitative methods. The following types of fit testing equipment will be available: Saccharin (sweetener) and Bitrex (bitter) qualitative fit test kits using squeeze-bulb nebulizers as well as powered pumps using Qfit. Quantitative fit testing with the TSI PortaCount (models 8020, N95 Companion, 8030 & 8038), and the OHD Fit Tester 3000/QuantiFit. Class size will be limited to ensure a favorable faculty to student ratio. Students will learn how to set-up, operate, maintain, troubleshoot, analyze, and interpret fit test results. Where appropriate, students will learn how to calibrate testing equipment and record results. All course materials, supplies, equipment, and reference manuals will be provided. Students will also learn how to disassemble, clean, reassemble, and inspect respirators for common problems. The workbook alone is a valuable reference for solving fit testing problems in the future. This course uses a combination of lecture and small practicum groups to ensure students have ample time to practice and learn fit testing techniques. The second day provides students sufficient time to concentrate on the particular methods of interest to them. The "Hands-On" approach is emphasized in this course. Students will fit test several different make and model respirators, not just one. Pg 7 of 8 Individuals who plan to attend the fit testing workshop, but have little or no experience with respiratory protection should take the one day overview class in addition to the 2-day fit testing workshop. The fit testing workshop provides an opportunity to see and experience many different types of commonly used fit testing methods (qualitative and quantitative). A substantial discount is given when both courses are taken. Dr. McKay is the current chair of the ANSI Z88.10 Respirator Fit Testing sub-committee, a voting member of the full ANSI Z88 Respiratory Protection Committee, the AIHA Respiratory Protection Committee, and others. Fit Testing Refresher & Advanced Topics: This 1-day course is specifically designed for the person who has been conducting fit tests, but has not had formal training or needs a review. This course reviews OSHA fit testing requirements and helps the operator understand why poorly fitting respirators pass fit testing and why good fitting respirators fail. It is an excellent refresher for persons familiar with fit testing, but has limited formal training or needs a refresher. It also provides an opportunity to discuss advanced topics not covered during a typical 2-day fit testing workshop due to time limitations. This course is also valuable for respirator program administrators who need a better understanding of fit testing procedures and assurance that their fit testing program is being run properly. The emphasis of this course is on quantitative fit testing with the TSI PortaCount, although many of the concepts are applicable to other fit test methods. Partial Listing of Topics Review of fit test procedures Facial hair: issues & solutions Selection process Comfort assessment Interference with PPE Establishing pass/fail criteria Interpretation of fit test results Why user seal checks fail to detect leakage Why user seal checks create leaks not present Proper use of fit test adapters Selecting sample probe location Why leaking respirators pass fit testing Why good fitting respirators fail fit testing What does a high fit factor really mean Wear time & non wear time issues Understanding fit factor vs protection When is quantitative fit testing required? Opportunity to get answers to your questions © 2014, All rights reserved, Roy McKay, Ph.D. This course can also be given on-site. Respirator Training at Your Location: A variety of respirator training programs are available on-site. Courses available include: * Fit Testing Refresher & Advanced Topics * How to Develop a Cartridge Change Out Schedule (1 day) * Respirator Selection (1 to 1.5 days) * Fit Testing for Health Care Professionals (1 day) * Basics of a Respiratory Protection Program (2 days) * Overview of Respiratory Protection (1 day) * Respirator Fit Testing: Quantitative (1 or 2 days) * Respirator Fit Testing: Qualitative (1day) * Fit Testing at your workplace. Not a course, but a hands-on program with your staff and equipment. To Be Removed from email List: If you wish to be removed from this list, please click "reply" and put "Remove" in the subject heading. If your email address has recently changed or have more than one email address, provide both addresses in the body of the email. To be Added to our Newsletter: To be added to our Newsletter, go to www.DrMcKay.com There is no cost to subscribe. Your email address is NOT given to any other source. Newsletters are sent 2 - 3 times per year. If you Receive Duplicate Newsletters: Click "reply" and put "Remove" in the subject heading of the email address you wish to have removed as described above. Thank you for your continuing support. Students attending our programs help support our graduate training programs and respirator research projects. We hope to see you at a future training course. Roy McKay, Ph.D. Course Director University of Cincinnati www.DrMcKay.com Dr. McKay does not receive any public or private funding for this educational service. The opinions in this newsletter are those of Dr. McKay and not the University of Cincinnati. Pg 8 of 8
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