Respirators in Health Care
Considerations for Routine and Surge Use
Committee on the Use of Elastomeric Respirators in Health Care
Linda Hawes Clever, Bonnie M. E. Rogers,
Olivia C. Yost, and Catharyn T. Liverman, Editors
Board on Health Sciences Policy
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract #200-2011-38807 (Task Order 2) between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48515-9
International Standard Book Number-10: 0-309-48515-0
Digital Object Identifier: https://doi.org/10.17226/25275
Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: 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. doi: https://doi.org/10.17226/25275.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
COMMITTEE ON THE USE OF ELASTOMERIC RESPIRATORS IN HEALTH CARE
LINDA HAWES CLEVER (Co-Chair), California Pacific Medical Center
M. E. BONNIE ROGERS (Co-Chair), University of North Carolina Occupational Safety and Health Education Research Center
GLORIA ADDO-AYENSU, Fairfax County Department of Health
GIO J. BARACCO, University of Miami Miller School of Medicine and Miami Veterans Affairs Healthcare System
JIM CHANG, University of Maryland Medical Center
CHRISTOPHER FRIESE, University of Michigan School of Nursing
ROBERT HARRISON, University of California, San Francisco, School of Medicine
SUNDARESAN JAYARAMAN, Georgia Institute of Technology
JAMES S. JOHNSON, JSJ and Associates
BRUCE LIPPY, The Center for Construction Research and Training
ALLISON MCGEER, Mount Sinai Hospital and University of Toronto
ANN-CHRISTINE NYQUIST, University of Colorado School of Medicine
MIKE SCHMOLDT, Argonne National Laboratory
SKIP SKIVINGTON, Kaiser Permanente
PATRICIA STONE, Columbia University School of Nursing
TENER GOODWIN VEENEMA, Johns Hopkins University
CATHARYN T. LIVERMAN, Study Director
OLIVIA C. YOST, Associate Program Officer
KATIE LAWALL, Senior Program Assistant (through July 2018)
JUDY ESTEP, Program Associate (from July 2018)
DANIEL BEARSS, Senior Research Librarian
ANDREW M. POPE, Director, Board on Health Sciences Policy
This page intentionally left blank.
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
MARY T. BESSESEN, University of Colorado Denver
HOWARD J. COHEN, Consultant
BARBARA DEBAUN, Cynosure Health
TRISH PERL-DELISLE, UT Southwestern Medical Center
ROBERT M. ENINGER, Air Force Institute of Technology
RACHAEL JONES, University of Illinois Chicago
WILLIAM H. KOJOLA, AFL-CIO (retired)
SUZET M. MCKINNEY, Illinois Medical District Commission
JEFFREY C. NESBITT, Mayo Clinic
TERRI REBMANN, Saint Louis University
MARK SHIRLEY, Sutter Health
PRITISH K. TOSH, Mayo Clinic
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by ELAINE L. LARSON,
Columbia University, and LINDA A. MCCAULEY, Emory University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
This page intentionally left blank.
Boxes, Figures, and Tables
1-2 Historical Context: Diseases of Workers
2-1 Case Study: Respirator Use by an International Construction Firm
2-2 Case Study: Respirator Use by a National Remediation Contractor
2-3 Case Study: Respirator Use at the World Trade Center Cleanup
2-4 Case Study: Respirator Use in the Nuclear Industry
2-5 Description of Protection Factor Studies
2-6 OSHA Procedures for Cleaning Respirators
3-1 Health Care Worker Competencies in Respiratory Protection
3-2 Example of Stockpiling Needs and Comparative Costs for a Single High-Exposure-Risk Employee
3-3 Kaiser Permanente’s Experience with Stockpiled Respirators During the 2009 H1N1 Epidemic
3-4 Key Components of Safety Culture Change
1-1 Major types of air-purifying respirators currently used in health care
2-1 Modern reusable elastomeric respirator
2-2 Reusable elastomeric respirator examples
2-3 Diagram of a half-facepiece reusable elastomeric respirator
2-4 Overview of respirator use in industry
3-1 Use of elastomeric respirators in health care: viewpoints of stakeholders
4-1 A structured approach to evidence-based performance requirements for health care respirators
4-2 Comfort to compliance: factors influencing the comfort of elastomeric respirators
4-3 CleanSpace Ultra powered air-purifying respirator
4-4 FluView weekly influenza surveillance report: week ending May 19, 2018
S-1 Routine and Surge Use of Reusable Elastomeric Respirators
1-1 Health Care Workers, Location of Employment
1-2 Comparison of Medical Masks and Respirators
1-3 Hierarchy of Controls in the Context of the Treatment of a Patient with an Airborne Transmissible Disease
1-4 Efficiency Ratings for Respirator Filters
1-5 Overview of the Strengths and Limitations of Disposable Filtering Facepiece Respirators for Use in Health Care
1-6 Strengths and Limitations of Powered Air-Purifying Respirators for Use in Health Care
2-1 Examples of Jobs and Contaminants That Commonly Involve the Use of Reusable Elastomeric Respirators
2-2 Recent Studies on the Performance of Half-Facepiece Reusable Elastomeric Respirators
2-3 Assigned Protection Factors
2-4 Overview of Research on the Cleaning and Disinfection of Reusable Elastomeric Respirators in Health Care
2-5 Examples of Manufacturer Instructions for the Cleaning and Disinfection of Half-Facepiece Reusable Elastomeric Respirators
2-6 Benefits and Limitations of the Use of Reusable Elastomeric Respirators at the University of Maryland Medical Center
2-7 Benefits and Limitations of the Use of Reusable Elastomeric Respirators at the Texas Center for Infectious Disease
3-1 Annual RPD Pandemic Stockpiling Costs for a Population of 1 Million, per Strategy
3-2 Overview of 2009–2010 H1N1 Policies and Practices Regarding Personal Protective Equipment and H1N1 Influenza
4-1 Project BREATHE’s Major Categories and Desirable Performance Objectives for Health Care Respirators and Respiratory Protection Programs
5-1 Routine and Surge Use of Reusable Elastomeric Respirators
This page intentionally left blank.