Conducting CWHSP Spirometry during COVID-19

COVID-19 and Routine Spirometry
Routine Spirometry as part of the Coal Workers’ Health Surveillance Program

On May 25, 2021, NIOSH updated its recommendations to state that spirometry testing, as part of the Coal Workers’ Health Surveillance Program, can resume if recommended infection prevention and control (IPC) precautions are implemented, guidance from state and local health departments is followed, and information about community transmission of SARS-CoV-2 is considered.

Since the original NIOSH recommendation in March 2020 to defer spirometry for the CWHSP due to concerns about possible SARS-CoV-2 transmission related to testing individuals with active infection, many clinics have incorporated recommended IPC measures to mitigate SARS-CoV-2 transmission and protect their staff and clients. Additionally, safe COVID-19 vaccines effective at preventing infection and illness, particularly severe illness, among those vaccinated have received Emergency Use Authorization from the US Food and Drug Administration (FDA) and everyone 12 years and older is now eligible to get vaccinated. SARS-CoV-2 transmission in these clinics will be further minimized if staff and clients are vaccinated.

CWHSP-approved spirometry clinics are encouraged to review detailed guidance and best practices provided below to determine if spirometry testing as part of the CWHSP can resume at their facility. NIOSH will continue to update these recommendations as conditions evolve.

Conducting CWHSP Spirometry during the COVID-19 Pandemic

NIOSH-approved spirometry facilities that resume spirometry services for miners participating in the CWHSP should adhere to the following conditions and best practices. These best practices are adapted from guidance from CDC, American Thoracic Society (ATS), and American College of Occupational and Environmental Medicine (ACOEM). The ATS and ACOEM recommendations address both aerosol and droplet exposure protections.

  • In addition to screening staff daily, screen the miner for symptoms suggestive of COVID-19 within 72 hours but not more than 7 days prior to spirometry testing AND upon arrival for their appointment. Spirometry testing should be deferred if symptoms suggestive of COVID-19 are reported (see “Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19” for further details).
  • Perform spirometry only in an airborne infection isolation room or dedicated well-ventilated room under negative pressure (meaning that air flows from outside of the room into it). The room should have a minimum of 6 air changes per hour (ACH) through a combination of existing heating, ventilation, and air conditioning (HVAC) systems and portable high-efficiency particulate air (HEPA) air cleaners (see “Ventilation in Buildings”).
    • If portable CWHSP-approved spirometers are available, testing may be performed outdoors.
  • If community transmission for the past 7 days is moderate, substantial, or high, the transmission risk associated with the spirometry procedure is potentially increased. If community transmission is occurring, it is more protective for spirometry to be performed by fully vaccinated CWHSP-approved technicians. Restricting spirometry testing to fully vaccinated miners, who will be less likely to have SARS-CoV-2 infection, will also be more protective.
    • If community transmission and/or vaccination status is unknown or not determined, or the miner is known not to have been vaccinated, then the use of local source control ventilation with HEPA filtration is recommended.
    • If local source control is not utilized, then the wait time between test subjects should be sufficient to allow for adequate dilution of aerosols generated during the procedure. The exact time required for adequate dilution of aerosols will depend on the ACH and room air mixing at a 99% removal efficiency in the room used for spirometry (see “Ventilation FAQs: How long will it take to dilute the concentration of infectious particles in a room once they are generated?”). Consider consulting an HVAC professional to determine these characteristics for your specific space.
  • Instruct the miner to use respiratory and cough etiquette throughout the testing period.
  • Instruct the miner to wear an FDA-cleared surgical mask as much as possible in between maneuvers to minimize aerosol dispersion.
  • Provide facility staff with appropriate personal protective equipment (PPE), including a fit tested NIOSH-approved N95 respirator (or equivalent or higher-level respirator) worn in compliance with OSHA’s Respiratory Protection Standard, gown, gloves, and eye protection/face shield and training on how to don and doff PPE appropriately. Disposable PPE such as gowns, gloves, and face shields should be discarded after each use and re-usable PPE should be cleaned according to the manufacturer’s instructions, using disinfectants from EPA List N: Disinfectants for Coronavirus (COVID-19).
  • Maintain a > 6 feet of distance between the miner and facility staff, when possible.
  • Miner and facility staff should perform hand hygiene with an alcohol-based hand sanitizer with 60–95% alcohol or by washing their hands with soap and water before and after testing.
  • Only necessary equipment should be kept in the testing space.
  • Use in-line antibacterial and antiviral filters recommended by the spirometer manufacturer and disinfect reusable equipment after each test session according to the manufacturer’s instructions.
  • Follow all applicable precautions from state and local health departments and the CDC with regards to IPC practices for routine healthcare delivery to protect patients, staff, and others entering facilities.
  • All CWHSP spirometry test reports, corresponding data file, and completed forms must be submitted to NIOSH via SAMS within 14 calendar days of testing a miner. Required forms and reports include: Miner Identification Document, Respiratory Assessment Form, Spirometry Results Notification Form, and Clinic’s pre-approved Spirometry Test Report. Required PDF forms can be found here: CWHSP Spirometry Forms (see section – Spirometry Clinic Information / Forms to be used after clinic approval).