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Reusable respirators are an effective and viable option for protecting health care personnel

 

WASHINGTON – Half-facepiece reusable elastomeric respirators are an effective and viable option for protecting health care workers from exposure to airborne transmissible contaminants or infectious agents — for example, influenza virus — during day-to-day work or with a sudden or rapid influx of patients, such as during a public health emergency, says a new report from the National Academies of Sciences, Engineering, and Medicine. Implementation challenges including storage, disinfection, and maintenance; training and education; user comfort and tolerability; and supply logistics and emergency stockpiling need to be addressed.

Respirators are one component of a range of administrative, engineering, and environmental hazard controls and prevention strategies used in health care to protect workers from exposure to airborne hazards during patient care and laboratory analysis, and while handling hazardous medication or waste. Reusable respirators (made from elastomeric or flexible rubber-like materials) are the standard respiratory protection device used in many industries, especially for industrial purposes, and their durability and reusability make them desirable for stockpiling in case of emergencies. They are not used widely in health care, however. Only two U.S. health institutions were identified by the study committee as using reusable elastomeric respirators either exclusively or primarily. Most health facilities use filtering facepiece respirators, often called N95s, which are disposable after one use or in between seeing patients.

The advantages of routine use of elastomeric respirators include increased familiarity of staff with these respirators and the continued improvement of policies and practices for cleaning, disinfection, and maintenance, leading to better preparedness during an emergency or pandemic situation. A smooth transition to surge use would be expedited and enhanced if reusable elastomeric respirators were a part of a health care facility’s day-to-day respiratory protection program.

Addressing the respiratory needs of health care workers across their wide range of settings and jobs — including, for example, home health caregivers, rural clinic personnel, nursing home staff, and hospital staff — is an ethical imperative, the report says. It will require the design of innovative reusable respirators and the implementation of robust respiratory protection programs. These should take into account the distinctive characteristics of the health care workplace, including responsibilities of caring for multiple patients with varying health conditions; sudden and non-routine need for respiratory protection; and the possibility of needing to address unknown, potentially lethal, and highly transmissible infectious agents.

In addition, urgent action is needed to resolve gaps in knowledge and leadership on transmissibility of airborne contaminants or infectious agents. This includes the lack of standardized processes for the cleaning and disinfection of reusable respirators, the need for consistent guidance and standards by regulatory and policymaking authorities, and the need to establish accountability policies for each facility’s respiratory protection program. The committee developed a set of recommendations for the National Institute for Occupational Safety and Health, National Center for Immunization and Respiratory Diseases, professional associations, and accrediting organizations, among others, to spur research; enable effective respiratory protection programs, training, and education; and ensure rapid and seamless implementation.

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The study was sponsored by the Centers for Disease Control and Prevention. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit nationalacademies.org. A committee roster follows.

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Download the report at http://www.nationalacademies.org/ElastomericRespirators

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Copies of Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE

Health and Medicine Division

Board on Health Sciences Policy

Committee on the Use of Elastomeric Respirators in Health Care

Linda Hawes Clever* (co-chair)

Founding Chair

Department of Occupational Health

California Pacific Medical Center, and

Clinical Professor of Medicine

University of California

San Francisco

M. E. Bonnie Rogers (co-chair)

Director

North Carolina Occupational Safety and Health Education Research Center, and

Director

Occupational Health Nursing Program, and

Professor

Public Health Leadership Program

University of North Carolina

Chapel Hill

Gloria Addo-Ayensu

Director

Department of Health

Fairfax County

Fairfax, Va.

Gio J. Baracco

Professor of Clinical Medicine

Division of Infectious Diseases

Miller School of Medicine

University of Miami

Miami

Jim Chang

Director of Safety and Environmental Health

University of Maryland Medical Center

Baltimore

Christopher Friese

Elizabeth Tone Hosmer Professor of Nursing, and

Director

Center for Improving Patient and Population Health

University of Michigan

Ann Arbor

Robert Harrison

Clinical Professor of Medicine

Division of Occupational and Environmental Medicine

University of California

San Francisco

Sundaresan Jayaraman

Kolon Professor

School of Materials Science and Engineering, and

Founding Director

Kolon Center for Lifestyle Innovation

Georgia Institute of Technology

Atlanta

James S. Johnson

Consultant

JSJ and Associates

Pleasanton, Calif.

Bruce Lippy

Director of Safety Research

CPWR, The Center for Construction Research and Training

Silver Spring, Md.

Allison McGeer

Professor

Department of Laboratory Medicine and Pathobiology

Dalla Lana School of Public Health

University of Toronto

Toronto

Chris Nyquist

Professor of Pediatrics-Infectious Diseases, and

Medical Director for Infection Prevention and Control, and

Medical Director for Occupational Health

Children’s Hospital Colorado, and

School of Medicine

University of Colorado

Aurora

Mike Schmoldt

Program Industrial Hygienist

Argonne National Laboratory

Richland, Wash.

Skip I. Skivington

Vice President of Health Care Continuity Management and Support Services

Kaiser Permanente

Oakland, Calif.

Patricia Stone

Centennial Professor of Health Policy, and

Director

Center for Health Policy

School of Nursing

Columbia University

New York City

Tener Goodwin Veenema

Professor

School of Nursing, and

Professor,

Bloomberg School of Public Health

Johns Hopkins University

Baltimore

STAFF

Cathy T. Liverman

Staff Officer

*Member, National Academy of Medicine

 

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