Preparing for an Influenza Pandemic Personal Protective Equipment for Healthcare Workers (2008) / Chapter Skim
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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. Three critical areas were identified that require expeditious research and policy action: (1)
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The committee believes that improvements can be made so that healthcare workers will have PPE that provides protection against influenza transmission based on a rigorous risk assessment with solid scientific evidence. The recommendations provided in this report are intended to serve as a framework and catalyst for a national PPE action plan that is an integral part of the overall national plan for an influenza pandemic.
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Administrative controls include the policies, standards, and procedures set within an organization to limit hazardous exposures and improve worker safety, including the provision of appropriate and effective protective equipment. At the individual level, responsibilities incumbent on the healthcare worker include appropriate use of PPE as well as adherence to work safety practices.
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The recent SARS outbreaks have emphasized the importance of attention to worker safety and PPE. Standard infection control precautions now stipulate specific PPE and other measures for protection against contact, droplet, and aerosol transmission of hazardous agents.
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. The committee examined the range of issues relevant to healthcare PPE, particularly in planning for a potential influenza pandemic, and developed a set of recommendations2 focused on three major areas requiring action to ensure the safety of healthcare workers: • Understand influenza transmission.
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The next pandemic may come from a human or an avian influenza strain; the virulence of the strain will determine its impact on the healthcare system. Influenza transmission research should become an immediate and short-term research priority so that effective prevention and control strategies can be developed and refined.
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In this time of preparation for an influenza pandemic, the realization of how little is known about critical aspects of the disease should prompt immediate action to coordinate multiple resources and a diversity of research expertise to address the unknowns regarding influenza transmission and prevention. Recommendation: Initiate and Support a Global Influenza Research Network The Department of Health and Human Services, in collabo ration with U.S.
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Each healthcare employer should assume responsibility for taking an active role in facilitating, promoting, and requiring safety actions. Healthcare facilities need to foster and promote a strong culture of safety that includes a commitment to worker safety, adequate access to safety equipment, and extensive training efforts that utilize protocols requiring specific safety actions and detailing the consequences for noncompliance.
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Recommendations: Emphasize Appropriate PPE Use in Patient Care and in Healthcare Management, Accreditation, and Training Appropriate PPE use and healthcare worker safety should be a priority for healthcare organizations and healthcare work ers, and in accreditation, regulatory policy, and training. Identify and Disseminate Best Practices for Improving PPE Compliance and Use CDC and the Agency for Healthcare Research and Quality (AHRQ)
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. In developing evidence-based performance requirements, the ideal data acquisition process would involve use of the PPE component in the field and assessing the requirements; however, in the event this is not feasible, the data acquisition process should, at the very least, simulate the real-world usage of the specific component of the PPE ensemble.
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. Post-marketing evaluation of healthcare PPE products should be carried out through a range of approaches in multiple types of healthcare settings and including workers performing a full range of common high-exposure tasks.
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Additional resources are needed to extend its partnering initiatives with other agencies and organizations and with academia and manufacturers. In working on its charge to examine PPE for healthcare workers in the event of an influenza pandemic, the committee became aware of substantial gaps in knowledge regarding the design and implementation of PPE for family members and others who will provide care to influenza patients during a pandemic or who wish to use preventive measures to avoid influenza transmission.
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Increase Research on the Design and Engineering of the Next Generation of PPE NIOSH, the Department of Homeland Security, the Depart ment of Defense, manufacturers, and other relevant organizations and agencies should fund research directed at the design and development of the next generation of respira tors, gowns, gloves, and eye protection for healthcare workers that would enhance their safety and comfort. Establish Measures to Assess and Compare the Effectiveness of PPE NIOSH, through NPPTL, should develop and promote a vali dated set of measures for comparing the effectiveness of PPE products.
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Strengthen Pre-market Testing of PPE for Healthcare Workers FDA, NIOSH, and other relevant agencies and organizations should strengthen pre-market testing requirements for healthcare PPE by requiring field testing of PPE prior to ap proval and by reevaluating the FDA medical device classification for healthcare PPE. Testing requirements should use rigorous standards while also providing expedi tious review of innovative approaches.
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These recommendations provide a framework for a national PPE action plan that is an integral part of the overall national plan for an influenza pandemic. The committee believes that improvements should be made so that healthcare workers have PPE that provides protection against influenza transmission based on a rigorous risk assessment with solid scientific evidence.
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Until more is known about influenza transmission, it will be critical to follow current infection control practices, to ensure that all forms of protections are available to healthcare workers, and to heighten their knowledge of PPE and its use, while also obtaining the input of healthcare workers in designing, testing, and developing the next generation of PPE. It is hoped that this report will catalyze initiatives to promote a strong emphasis on the safety of healthcare workers.
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Healthcare worker safety is essential for patient safety and patient care. Being prepared for an influenza pandemic places a priority on protecting the healthcare workforce.
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