Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases Personal Protective Equipment for Healthcare Personnel: Update 2010 (2011) / Chapter Skim
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SCOPE OF THE REPORT The 2009–2010 H1N1 experience and its accompanying unanswered research questions provided the impetus for the National Personal Protective Technology Laboratory (NPPTL) at the National Institute for Occupational Safety and Health (NIOSH)
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Specific attention was sought on issues re lated to the research needed to determine the type of respiratory protection needed for the given exposure, to determine the re quirements for protective ensembles to provide an appropriate level of protection based on work tasks, and to improve function ality and address human factor issues such as wearability, com pliance, and communications; • necessary certification, testing, and standards development is sues; and • priorities and resources for research and certification efforts. To accomplish its charge, the committee held three meetings and gathered information through a scientific workshop that included a public comment session, through discussions with numerous individuals in the infection control and occupational safety and health fields, and through a review of the relevant literature.
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Many PPE issues relevant to healthcare personnel are also directly relevant to the PPE needs of workers in other occupations, as well as the general public. PPE FOR HEALTHCARE PERSONNEL The term "personal protective equipment" encompasses the specialized clothing or equipment worn by workers for protection against health and safety hazards.
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UPDATE ON PROGRESS: 2007 TO 2010 Transmission of Influenza and Other Viral Respiratory Diseases Animal studies have found that the ferret and guinea pig models appear to be highly representative of humans in terms of their susceptibility to infection, the influenza viral strains that display a transmissible phenotype, and the kinetics with which transmission occurs. Experiments per
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Observational and controlled studies relevant to PPE use and transmission of influenza or other viral respiratory diseases are limited because study protocols were not usually in place for 2009 H1N1 or for recent seasonal flu periods, and studies have not provided adequate power to answer questions regarding the effectiveness of using PPE in reducing or preventing disease transmission. Designing and Engineering Effective PPE PPE is a critical component in the hierarchy of controls used to protect healthcare personnel from influenza and other viral respiratory diseases.
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At a minimum, consideration should be given to the user, the device, the task, and the general work and organizational context. The growing acknowledgment of contextual and organizational factors means that research on PPE and healthcare personnel is closing in on the larger body of occupational safety research, which increasingly emphasizes those factors in understanding occupational safety performance.
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RECOMMENDATIONS: A SYSTEMS APPROACH TO PPE RESEARCH Providing care to ill or injured patients involves a range of potentially hazardous exposures for healthcare personnel. Current infection control precautions address this challenge by providing guidance on PPE and other precautions that varies depending on the mode of transmission of
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In many cases in industrial settings, this level of specificity is available for chemical exposures, although other industrial settings with unknown or mixed exposures continue to pose challenges. Reaching that point for protecting healthcare personnel will require concerted research efforts.
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Recommendation: Develop and Implement a Comprehensive Research Strategy to Understand Viral Respiratory Disease Transmission The National Institutes of Health, in collaboration with other research agencies and organizations, should develop and fund a comprehensive research strategy to improve the un derstanding of viral respiratory disease transmission, includ ing, but not limited to, examining the characteristics of influenza transmission, animal models, human challenge stud ies, and intervention trials. This strategy should include • an expedited mechanism for funding these types of studies and • clinical research centers of excellence for studying influenza and other respiratory virus transmission.
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Recommendation: Examine the Effectiveness of Face Masks and Face Shields as PPE NPPTL should investigate the effectiveness of face masks and face shields in preventing transmission of viral respiratory diseases. Recommendation: Improve Fit Test Methods and Evaluate User Seal Checks NPPTL should develop novel, simpler fit test methods and evaluate the effectiveness of performing user seal checks on N95 respirators.
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, • exploring the links between patient safety and healthcare worker safety and health that are relevant to the use of PPE, and • identifying and evaluating strategies to mitigate or ganizational barriers that limit the use of PPE by healthcare personnel. Recommendation: Identify and Disseminate Effective Leader ship and Training Strategies and Other Interventions to Improve PPE Use NIOSH and other relevant agencies and professional organi zations should support intervention effectiveness research to assess strategies, including innovative participatory ap proaches to training, for healthcare and supervisory staff at all levels to improve PPE usage and other related outcomes across the range of healthcare settings.
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Recommendation: Clarify PPE Guidelines for Outbreaks of Novel Viral Respiratory Infections NIOSH, other divisions of CDC, OSHA, and other public health agencies should develop a coordinated process to make, announce, and revise consistent guidelines regarding the use of PPE to be worn by healthcare personnel during a verified sustained national/international outbreak of a novel viral respiratory infection. The agencies should tailor their guidance in a timely and coordinated manner as the viru lence, contagiousness, and affected populations are further characterized.
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Recommendation: Establish PPE Regulations for Healthcare Personnel CDC, including NIOSH, and OSHA should develop and promulgate guidelines and regulations that are consistent re garding the use of PPE by healthcare personnel for influenza and other viral respiratory diseases: • To assist employers in complying with the OSHA PPE standard, OSHA should specify the voluntary consensus standards that are required to be met for non-respirator PPE (e.g., gowns, gloves, face shields, face masks) in the event of influenza and other viral respiratory diseases.
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The committee hopes that this review will jumpstart and strengthen improvements in PPE for healthcare personnel that could be relevant to a range of viral respiratory diseases.
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