Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel Update 2010
In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus as well as questions regarding personal protective equipment (PPE) for healthcare personnel. Because researchers still have a lot to learn about how influenza is transmitted from person to person, one major question that arose during the H1N1 influenza pandemic was determining what types of PPE (particularly face masks or respirators) are needed to protect healthcare personnel from disease transmission.
In light of the unanswered research questions following the 2009 H1N1 influenza pandemic, the National Personal Protective Technology Laboratory (NPPTL) at the National Institute for Occupational Safety and Health (NIOSH) asked the Institute of Medicine (IOM) to conduct a study updating the progress on research and identifying future directions for PPE for healthcare personnel since releasing the 2008 IOM report Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. New horizons in PPE research and attention to PPE innovations offer the promise of improvements in healthcare worker safety. The focus of research efforts often shifts to other health concerns between pandemics so continuing the research momentum is critical to ensure that the nation is prepared for the next influenza pandemic.
Protecting Healthcare Personnel with PPE
PPE encompasses the specialized clothing or equipment used by personnel for protection against health and safety hazards. For healthcare personnel, PPE may include respirators, face masks, gloves, gowns, eye protection, and face shields. In an influenza pandemic, preventing the spread of the virus requires that personnel know how to properly wear and use the appropriate PPE, yet in the past this knowledge has been limited. In particular, understanding the differences between and correct uses of respirators and face masks can be challenging for healthcare personnel. Respirators are specifically designed to provide respiratory protection by purifying the air inhaled by the wearer through filtering materials or by independently supplying breathable air. Research shows that the major concerns with the respirators are the filtration and the fit—that is, the effectiveness of the filter and the extent to which the respirator has a tight seal against the wearer’s face to restrict leakage. In contrast, face masks, including surgical masks, are loose-fitting coverings of the nose and mouth; face masks are not designed or certified to protect the wearer from exposure to respiratory hazards.
Understanding the Transmission of Influenza and Other Viral Respiratory Diseases
Much of the discussion regarding how influenza is transmitted has focused on the modes of transmission— droplet spray, aerosol, and direct or indirect contact. While researchers have made some progress in understanding these different modes of influenza virus transmission, the extent to which each mode contributes to the overall spread of illness is still unclear. In addition, few studies have focused on effective PPE interventions to reduce the transmission of influenza in hospitals or other healthcare facilities. These studies are needed to guide policy makers seeking to ensure the health and safety of healthcare personnel. Observational and controlled studies relevant to PPE use and transmission of influenza or other viral respiratory diseases have been limited because few study protocols were in place during the 2009 H1N1 and recent seasonal flu periods.
Innovating and Strengthening PPE Design and Testing
While research has led to improvement in the filtration capabilities of respirators, efforts continue to work toward improving the fit of these protective devices. Current challenges with filtering facepiece respirators include improper fit and leakage as a result of not sealing properly to the face. New technologies need to be designed to improve the fit and reduce inward leakage of these respirators. Although the physiological impact of respirators (for example, comfort, breathability, and retention of heat) has been studied in depth, such information is lacking regarding other types of PPE. Researchers also have studied decontamination methods that do not affect the physical characteristics of respirators, but most have yielded inconclusive results and should continue to be studied. Another area that should be explored is the role that face masks and face shields play as PPE for viral respiratory diseases.