Standing Committee on Personal Protective Equipment for Workplace Safety and Health

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Personal protective equipment (PPE) is a critical part of infection prevention and health care worker (HCW) protection. The COVID-19 pandemic revealed gaps in the ability of health care systems to ensure HCWs have adequate access to PPE during times of surge in demand, placing both HCWs and patients at risk. In March 2024, the National Academies convened a public workshop to identify opportunities to increase the use of reusable health care textiles (HCTs) used for PPE in health care settings. Speakers emphasized reusable textiles' potential to protect health care staff and their patients, reduce waste and environmental effects from disposable HCTs, prepare for future pandemics, and provide cost savings.

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122 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-71884-8
ISBN Ebook: 0-309-71885-6
DOI: https://doi.org/10.17226/27762

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National Academies of Sciences, Engineering, and Medicine. 2024. Reusable Health Care Textiles for Use in Personal Protective Equipment: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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The National Strategy for a Resilient Public Health Supply Chain lays out the U.S. government vision to protect the health and security of Americans by ensuring a supply chain for personal protective equipment (PPE) and technology (PPT), medical devices, medicines, and other public health supplies that is resilient against disruptions from pandemics and other biological threats. Additional forethought and collaboration amongst policy makers, manufacturers, and users is needed to make PPE and PPT innovation, standardization, stockpiling, and use more resilient.

The National Academies convened a public workshop in March 2023 to explore innovative approaches and technologies needed to update and streamline the U.S. standardization system for PPE and PPT in support of supply chain resiliency. Discussions included ways to improve the effectiveness, safety, supply stability, and accessibility of PPE and PPT designed for use in health care settings, by critical infrastructure workers, and by the general public. This Proceedings of a Workshop summarizes the discussions held during the workshop.

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166 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-70450-2
ISBN Ebook: 0-309-70451-0
DOI: https://doi.org/10.17226/27094

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National Academies of Sciences, Engineering, and Medicine. 2023. Personal Protective Equipment and Personal Protective Technology Product Standardization for a Resilient Public Health Supply Chain: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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To address approaches to the respirator approval process in the current landscape for both occupational and non-occupational use of respirators, the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Personal Protective Equipment for Workplace Safety and Health convened a virtual workshop, Current Issues in the Assessment of Respiratory Protective Devices: Nontraditional Workers and Public Use on August 4-5, 2020. Additionally, the workshop considered gaps in respiratory protection for outdoor workers and the general public. This publication summarizes the presentation and discussion of the workshop.

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152 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-68381-5
ISBN Ebook: 0-309-68382-3
DOI: https://doi.org/10.17226/25951

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National Academies of Sciences, Engineering, and Medicine. 2021. Current Issues in the Assessment of Respiratory Protective Devices for Occupational and Non-Occupational Uses: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities.

During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care.

Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices.

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226 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-48515-0
ISBN Ebook: 0-309-48516-9
DOI: https://doi.org/10.17226/25275

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National Academies of Sciences, Engineering, and Medicine. 2019. Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. Washington, DC: The National Academies Press.

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Both the Food and Drug Administration (FDA) and the National Institute for Occupational Safety and Health (NIOSH) have responsibilities for evaluating and regulating respiratory protective devices ("respirators") for health care workers. Respirators protect the user from respiratory hazards by either removing contaminants from the air (air-purifying respirators) or by supplying clean air from another source (air-supplying respirators). Respirators that are used in workplaces in the United States must be approved by NIOSH and meet standards and test results specified by regulation.

Respirators used by health care workers are air-purifying respirators that generally fall into three types: (1) disposable particulate filtering facepiece respirators (also termed N95s); (2) elastomeric respirators, also known as reusable respirators because they use a replaceable filter; or (3) powered air-purifying air respirators.

To provide input to NIOSH and FDA and to discuss potential next steps to integrate the two agencies' processes to certify and approve N95 respirators for use in health care settings, a workshop was held by the National Academies of Sciences, Engineering, and Medicine in August 2016. The workshop was focused on exploring the strengths and limitations of several current test methods for N95 respirators as well as identifying ongoing research and research needs. This publication summarizes the presentations and discussions from the workshop.

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76 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-45127-2
ISBN Ebook: 0-309-45128-0
DOI: https://doi.org/10.17226/23679

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National Academies of Sciences, Engineering, and Medicine. 2017. Integration of FDA and NIOSH Processes Used to Evaluate Respiratory Protective Devices for Health Care Workers: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Workshop_in_brief

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On April 30, 2015, the Institute of Medicine convened the public workshop "Developing a Performance Standard for Combination Unit Respirators." An estimated 20 million workers use personal protective equipment on a regular basis to protect themselves from job hazards. The workshop brought together user groups, manufacturer representatives, and government personnel to discuss the need and possible next steps for developing a performance standard for combination unit respirators. This report highlights the presentations and discussion of the workshop.

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8 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-37610-6
DOI: https://doi.org/10.17226/21765

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Institute of Medicine. 2015. Developing a Performance Standard for Combination Unit Respirators: Workshop in Brief. Washington, DC: The National Academies Press.

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Protecting 18 million United States health care workers from infectious agents - known and unknown - involves a range of occupational safety and health measures that include identifying and using appropriate protective equipment. The 2009 H1N1 influenza pandemic and the 2014 Ebola virus outbreak in West Africa have called raised questions about how best to ensure appropriate and effective use of different kinds of personal protective equipment such as respirators, not only to promote occupational safety but also to reduce disease transmission.

The Use and Effectiveness of Powered Air Purifying Respirators in Health Care is the summary of a workshop convened by the Institute of Medicine Standing Committee on Personal Protective Equipment for Workplace Safety and Health to explore the current state of practices and research related to powered air purifying respirator (PAPRs) and potential updates to performance requirements. Presentations and discussions highlighted current health care practices using PAPRs and outlined the research to date on the use and effectiveness of PAPRs in health care settings with a focus on the performance requirements. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care focuses on efficacy, current training, maintenance, supplies, and possible enhancements and barriers to use in inpatient, clinic, nursing home, and community (home) settings. This report also explores the strengths and weaknesses of using various approaches to health care PAPR standards.

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80 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-31595-6
ISBN Ebook: 0-309-31596-4
DOI: https://doi.org/10.17226/18990

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Institute of Medicine. 2015. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. Washington, DC: The National Academies Press.

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Letter

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Occupational health nurses (OHNs) are front-line advocates for preventing illness and injury and protecting health in a variety of workplace settings, including the areas of agriculture, construction, health care, manufacturing, and public safety. OHNs need education and training in respiratory protection in order to ensure both their safety and the safety of America's workers.

At the request of the National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health, the Institute of Medicine (IOM) examined existing respiratory protection curricula and made recommendations to improve education and training in respiratory protection for OHNs. The IOM finds that current respiratory protection education receives varying amounts of dedicated time and resources and is taught using a variety of approaches. Several recommendations are made to improve the respiratory protection education and training of OHNs.

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74 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-21548-X
ISBN Ebook: 0-309-21549-8
DOI: https://doi.org/10.17226/13183

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Institute of Medicine. 2011. Occupational Health Nurses and Respiratory Protection: Improving Education and Training: Letter Report. Washington, DC: The National Academies Press.

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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. In this book, the Institute of Medicine assesses the progress of PPE research and identifies future directions for PPE for healthcare personnel.

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200 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-16254-8
ISBN Ebook: 0-309-16255-6
DOI: https://doi.org/10.17226/13027

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Institute of Medicine. 2011. Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010. Washington, DC: The National Academies Press.

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When you purchase a product, you expect it to work. Construction workers on high-rise buildings need to be confident that their safety harnesses will arrest a fall. Firefighters need to know that their gloves and other protective equipment can withstand high temperatures. Healthcare workers administering highly toxic chemotherapy agents need to know that their gloves will withstand penetration. For personal protective technologies (PPT)—where the major purpose of the product is to protect the wearer against a hazard—a deficit in product effectiveness can mean injury, illness, or death. Examining the extent to which products meet specific performance or design criteria is the focus of conformity assessment efforts. For PPT conformity assessment, the ultimate goal is preventing worker illness, injury, or death from hazardous working conditions.

Certifying Personal Protective Technologies focuses on conformity assessment for occupational PPT—ensuring that PPT are effective in preventing or reducing hazardous exposures or situations that workers face in their jobs. Because respirators already have an extensive testing and conformity assessment process in place, this book specifically addresses conformity assessment processes for other types of PPT, including eye and face protection, gloves, hearing protectors, and protective clothing.

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166 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-15855-9
ISBN Ebook: 0-309-15856-7
DOI: https://doi.org/10.17226/12962

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Institute of Medicine. 2011. Certifying Personal Protective Technologies: Improving Worker Safety. Washington, DC: The National Academies Press.

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During an influenza pandemic, healthcare workers will be on the front lines delivering care to patients and preventing further spread of the disease. As the nation prepares for pandemic influenza, multiple avenues for protecting the health of the public are being carefully considered, ranging from rapid development of appropriate vaccines to quarantine plans should the need arise for their implementation. One vital aspect of pandemic influenza planning is the use of personal protective equipment (PPE)—the respirators, gowns, gloves, face shields, eye protection, and other equipment that will be used by healthcare workers and others in their day-to-day patient care responsibilities.

However, efforts to appropriately protect healthcare workers from illness or from infecting their families and their patients are greatly hindered by the paucity of data on the transmission of influenza and the challenges associated with training and equipping healthcare workers with effective personal protective equipment. Due to this lack of knowledge on influenza transmission, it is not possible at the present time to definitively inform healthcare workers about what PPE is critical and what level of protection this equipment will provide in a pandemic. The outbreaks of severe acute respiratory syndrome (SARS) in 2003 have underscored the importance of protecting healthcare workers from infectious agents. The surge capacity that will be required to reduce mortality from a pandemic cannot be met if healthcare workers are themselves ill or are absent due to concerns about PPE efficacy.

The IOM committee determined that there is an urgent need to address the lack of preparedness regarding effective PPE for use in an influenza pandemic. Preparing for an Influenza Pandemic : Personal Protective Equipment for Healthcare Workers identifies that require expeditious research and policy action: (1) Influenza transmission research should become an immediate and short-term research priority so that effective prevention and control strategies can be developed and refined. The current paucity of knowledge significantly hinders prevention efforts. (2) Employer and employee commitment to worker safety and appropriate use of PPE should be strengthened. Healthcare facilities should establish and promote a culture of safety. (3) An integrated effort is needed to understand the PPE requirements of the worker and to develop and utilize innovative materials and technologies to create the next generation of PPE capable of meeting these needs.

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View the entire set of Quality Chasm books from the Institute of Medicine.

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206 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-11046-7
ISBN Ebook: 0-309-11047-5
DOI: https://doi.org/10.17226/11980

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Institute of Medicine. 2008. Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. Washington, DC: The National Academies Press.

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NIOSH and the Occupational Safety and Health Administration (OSHA) share responsibility for overseeing respiratory protection in the workplace and have established regulations for this purpose. Specifically, NIOSH has issued regulations which define respirator testing and certification. OSHA has issued regulations which define conditions under which employers are required to maintain respiratory protection programs in general industry, shipyards, marine terminals, and construction.

In 2005, NIOSH contracted with the Institute of Medicine (IOM) to study the NIOSH-sponsored Anthrotech study along with its supporting information and reports, and to examine and report on the adequacy and relevance of the study protocol, the analyses conducted, the resulting anthropometric dataset, and the appropriateness of the respirator fit-test panels derived from the new dataset.

Assessment of the NIOSH Head-and-Face Anthropometric Survey of U.S. Respirator Users focuses on the establishment of the scientific base required for certification standards of respirators, not their use in the workplace. This report describes and analyzes the anthropometric measurements performed by Anthrotech for its NIOSH-sponsored study. This report looks at the survey methods used by Anthrotech in the study, and examines how Anthrotech analyzed its data to derive fit-test panels and suggests some ways that analysis could be improved. This report discusses future directions, pointing toward further analyses of the data and offers suggestions for moving from research to practice.

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122 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10398-3
ISBN Ebook: 0-309-66762-3
DOI: https://doi.org/10.17226/11815

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Institute of Medicine. 2007. Assessment of the NIOSH Head-and-Face Anthropometric Survey of U.S. Respirator Users. Washington, DC: The National Academies Press.

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Streamlining Regulatory Oversight of Respirators Used in Health Care Settings Will Improve Worker Protection

By Kristin J. Cummings, David Prezant, Mark Shirley, Melissa A. McDiarmid, May 13, 2024 | Discussion Paper

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By Mark Shirley, Linda Hawes Clever, David J. Prezant, and Kerri Rupe | March 17, 2017 | Discussion Paper

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Standing Committee on Personal Protective Equipment for Workplace Safety and Health

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Standing Committee on Personal Protective Equipment for Workplace Safety and Health

Reusable Health Care Textiles for Use in Personal Protective Equipment: Proceedings of a Workshop

Publications

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Brochure, Booklet, Pamphlet