Across the Spectrum of Research
Recommendation: Develop Standardized Terms and Definitions CDC and OSHA, in partnership with other relevant agencies and organizations, should work to develop standardized terms, definitions, and appropriate classifications to describe transmission routes and aerodynamic diameter of particles associated with respiratory disease transmission. This effort should involve a consensus from the industrial hy-giene, infectious disease, and healthcare communities.
Recommendation: Develop and Implement a Comprehensive Research Strategy to Understand Viral Respiratory Disease Transmission
The National Institutes of Health, in collaboration with other research agencies and organizations, should develop and fund a comprehensive research strategy to improve the understanding of viral respiratory disease transmission, includ-ing, but not limited to, examining the characteristics of influenza transmission, animal models, human challenge studies, and intervention trials. This strategy should include
- an expedited mechanism for funding these types of studies and
- clinical research centers of excellence for studying influenza and other respiratory virus transmission.
Safety to Efficacy: Basic Research (T1) to Clinical/Applied Research (T2)
Recommendation: Continue and Expand Research on PPE for Healthcare Personnel
NPPTL and other agencies, private sector companies, and other organizations should continue to advance research in designing and evaluating the effectiveness of respirator protection for healthcare personnel and expand its research efforts to improve and evaluate the effectiveness of gloves, gowns, face shields, and face masks in preventing the transmission of influenza or other viral respiratory diseases. Areas of focused research needs include
- effectiveness in preventing fomite, droplet spray, or aerosol transmission;
- decontamination and reusability;
- comfort, fit, and usability;
- impact on task performance; and
- development of technologies specifically for health-care personnel.
Recommendation: Examine the Effectiveness of Face Masks and Face Shields as PPE
NPPTL should investigate the effectiveness of face masks and face shields in preventing transmission of viral respiratory diseases.
Recommendation: Improve Fit-Test Methods and Evaluate User Seal Checks
NPPTL should develop novel, simpler fit-test methods and evaluate the effectiveness of performing user seal checks on N95 respirators.
Efficacy to Effectiveness: Clinical/Applied Research (T2) to Systems Research (T3)
Recommendation: Explore Healthcare Safety Culture and Work Organization
NIOSH and other relevant agencies, such as the Agency for Healthcare Research and Quality, and professional organizations should conduct research to better understand the role of safety culture and other behavioral and organizational factors on PPE usage in healthcare settings. These efforts should include
- conducting human factors and ergonomics relevant to the design and organization of healthcare work tasks to improve worker safety by reducing hazard-ous exposures and effectively using PPE (e.g., reduce unnecessary PPE donning and doffing),
- exploring the links between patient safety and healthcare worker safety and health that are relevant to the use of PPE, and
- identifying and evaluating strategies to mitigate organizational barriers that limit the use of PPE by healthcare personnel.
Recommendation: Identify and Disseminate Effective Leadership and Training Strategies and Other Interventions to Improve PPE Use
NIOSH and other relevant agencies and professional organizations should support intervention effectiveness research to assess strategies, including innovative participatory ap-proaches to training, for healthcare and supervisory staff at all levels to improve PPE usage and other related outcomes across the range of healthcare settings. To identify best prac-tices, efforts should be made to
- conduct observational studies of PPE use by healthcare personnel in different types of work settings;
- develop, implement, and evaluate comprehensive leadership and training strategies and interventions that go beyond simple knowledge-based training;
- design training interventions specifically for supervisory and managerial personnel in different types of healthcare settings;
- examine long-term practice change and safety culture implementation related to educational interventions;
- improve use and understanding of PPE by home and community healthcare personnel;
- develop assessment tools and metrics that take a broader approach to PPE and acknowledge the interaction of worker, task, and environmental factors; and
- be informed by a lessons-learned summit on PPE use by healthcare personnel during the 2009 H1N1 experience.
Effectiveness to Disease Reduction in Populations: Systems Research (T3) to Policy/Regulatory Research (T4)
Recommendation: Develop and Certify Powered Air-Purifying Respirators (PAPRs) for Healthcare Personnel
NPPTL should develop certification requirements for a low-noise, loose-fitting PAPR for healthcare personnel.
Recommendation: Move Forward on Better Fitting Respirators
NPPTL should continue rule making for total inward leak-age regulations that require respirators to meet fit criteria. To improve consumer and purchaser information on fit capabilities, NIOSH should establish a website to disseminate fit-test results for specific respirator models on an anthropometric (NIOSH) test panel, where such data exist.
Recommendation: Clarify PPE Guidelines for Outbreaks of Novel Viral Respiratory Infections
NIOSH, other divisions of the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), and other public health agencies should develop a coordinated process to make, announce, and revise consistent guidelines regarding the use of PPE to be worn by healthcare personnel during a verified sustained national/international outbreak of a novel viral respiratory infection. The agencies should tailor their guidance in a timely and coordinated manner as the virulence, contagiousness, and affected populations are further characterized.
Recommendation: Standards and Certification for Face Masks and Face Shields
NIOSH, OSHA, and standards-development organizations should develop the standards and certification processes needed to assess the performance of face masks and face shields as PPE. The development of standards and certification processes should be guided by research regarding their efficacy as PPE:
- OSHA and CDC should clarify that face masks are governed by the general PPE standard (29 CFR 1910.132) and not by the respiratory protection standard (29 CFR 1910.134).
- NIOSH should work with other agencies and standards-setting organizations to develop voluntary consensus standards and independent third-party testing and certification processes for face shields and face masks with specific tests for assessing prevention of transmission of viral respiratory diseases.
Recommendation: Establish PPE Regulations for Healthcare Personnel
The CDC, including NIOSH, and OSHA should develop and promulgate guidelines and regulations that are consistent regarding the use of PPE by healthcare personnel for influenza and other viral respiratory diseases:
- To assist employers in complying with the OSHA PPE standard, OSHA should specify the voluntary consensus standards that are required to be met for non-respirator PPE (e.g., gowns, gloves, face shields, face masks) in the event of influenza and other viral respiratory diseases.
- OSHA, with input from the CDC and other agencies and organizations, should work toward promulgating an aerosol-transmissible diseases standard that would include prevention of the transmission of influenza and other viral respiratory diseases.