INHALATION HAZARDS AND RESPIRATORY PROTECTIVE DEVICES
Respirators have long been used in work settings to keep individuals from breathing in inhalation hazards—dangerous substances in the air, such as gas or particles, including infectious agents (e.g., viruses and bacteria). In contrast to respirators, medical masks (and cloth face coverings, which have not typically been used in workplaces) are designed primarily to protect others nearby against infectious droplets produced by their wearers. Health care workers, for example, wear medical masks to avoid spreading infectious agents to their patients and use respirators, such as N95 filtering facepiece respirators, to protect themselves from becoming infected with such airborne agents as SARS-CoV-2 (which causes COVID-19). While the levels of protection vary across devices, personal devices that provide protection against inhalation hazards when used effectively are, for the purposes of this report, called respiratory protective devices. Whether they provide protection for the wearer and/or others nearby depends on both the specific device and the hazard in question.
The threats posed by inhalation hazards extend far beyond specific worker groups that have historically used respiratory protective devices in the workplace. The COVID-19 pandemic and extreme natural events, such as wildfires and mold growth indoors due to flooding after storms, have highlighted how these threats can reach every individual in the United States. More than ever, people are aware of the dangers present in the air they breathe and the damages to health that can result, including respiratory
infections and worsening of such common conditions as asthma and heart disease. It has also become clear that there are gaps in the nation’s ability to meet the needs of the public and workers for timely access to respiratory protective devices and guidance and support in their effective use.
GAPS IN THE CURRENT SYSTEM
In the United States, employers are required to ensure that employees are protected from hazards, including inhalation hazards. The Occupational Safety and Health Administration (OSHA) has primary responsibility for ensuring that employers meet those requirements and that workers have access to respiratory protection when needed. Respirators used in OSHA-mandated workplace respiratory protection programs (RPPs) adhere to specific requirements and are tested and approved by the National Institute for Occupational Safety and Health (NIOSH). However, not all workers are covered by OSHA or any other governmental authority. Workers exposed to inhalation hazards not usually found in their workplaces, such as wildfire smoke or airborne viruses, including SARS-CoV-2, may not have access to RPPs or may be unaware of how and when to use respiratory protective devices.
Although face coverings, medical masks, and respirators may be used by the public, none are specifically approved by federal agencies for use outside of occupational settings. Additionally, there is no formal, coordinated system in place to guide and educate the public on when and how to use a respiratory protective device and which devices individuals, including children, should wear. During the COVID-19 pandemic, this lack of trusted guidance, along with widespread misinformation, contributed to persistent confusion and disagreement concerning the need for use of and the protection provided by different kinds of devices. The COVID-19 pandemic also exposed severe limitations in the capacity of existing supply chains to meet demands for respiratory protective devices during public health emergencies.
RECOMMENDATIONS OF THE COMMITTEE
Increasing levels of air pollution, fueled in part by wildfires, and growing recognition of the importance of airborne transmission of infectious agents have focused attention on the need for respiratory protection against hazards beyond those faced by the small percentage of workers covered by RPPs. While it is impossible to know what will come next, the nation can be better prepared.
The Committee on Respiratory Protection for the Public and Workers Without Respiratory Protection Programs at Their Workplaces, convened
by the National Academies of Sciences, Engineering, and Medicine, used the best available science and drew on lessons learned to make recommendations addressing the critical need for a coordinated effort to improve communication and engagement around respiratory protection, secure the supply chain for these devices, and ensure that all individuals have access to the devices and associated guidance needed to protect themselves from inhalation hazards.
For the public, the committee’s recommendations focus on filling gaps in authorities and addressing fragmentation in responsibilities (see Chapter 7). The committee recommends that Congress establish an entity within the Department of Health and Human Services (HHS) with the authority, resources, and expertise necessary to coordinate and oversee the development, approval, and use of respiratory protective devices for the public. Working with federal partners and other relevant organizations, this entity would ensure that processes are in place to evaluate hazards continuously, identify appropriate respiratory protective devices when needed, engage with the public regarding what devices they should use and how to use them, and guide efforts to ensure adequate supplies of and access to such devices. The committee also recommends that HHS designate a laboratory to oversee the development of standards for and the assessment and approval of respiratory protective devices intended for use by the public.
While workplaces are generally under the oversight of OSHA, guided by its scientific partner NIOSH, there is room for improvement in worker protection. OSHA coverage has significant gaps that leave millions of workers without adequate respiratory protection. As discussed in Chapter 6, the committee recommends that OSHA’s respiratory protection requirements apply to all workers, a recommendation necessitating revision of the Occupational Safety and Health Act and updates to current state-level occupational safety and health programs. The committee also recommends that OSHA develop new standards and guidelines for such inhalation hazards as wildfire smoke and airborne infectious agents to indicate when respiratory protection is needed. Since many employers and workers will be unfamiliar with RPPs, OSHA and NIOSH will need to expand their programs to ensure that employers and workers know how to gain protection against inhalation hazards. These efforts will need to be built on a strong scientific foundation, and the committee also recommends that NIOSH conduct additional research to better understand and meet the needs of workers, including members of the most vulnerable and underserved populations, facing inhalation hazards.
While the COVID-19 pandemic was not the driving force for this report, the pandemic revealed gaps needing urgent attention, providing insights into current respiratory protection practices and systems for protecting workers and the public during a crisis, and pointing to what needs to change in the future. Immediate action is needed.