Reusable Elastomeric Respirators in Health Care Considerations for Routine and Surge Use (2019) / Chapter Skim
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5 Next Steps and Recommendations
5 Next Steps and Recommendations
Pages 175-186
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From page 175... ...
The committee's conclusions and recommendations focus on reusable elastomeric respirators, but given the task of exploring the feasibility of these respirators in health care settings, broader issues of respiratory protection for health care workers are integral to these discussions and are also addressed. DECISION FACTORS AND CONCLUSIONS: ROUTINE AND SURGE USE OF REUSABLE ELASTOMERIC RESPIRATORS Decision Factors In weighing its decisions regarding conclusions and recommendations, the committee explored a wide range of scientific and implementation issues regarding reusable elastomeric respirators and carefully examined the challenges and benefits of these respirators (see Table 5-1)
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From page 176... ...
TABLE 5-1 Routine and Surge Use of Reusable Elastomeric Respirators Definition Examples Advantages Challenges Routine Day-to-day Pulmonary Institutional Cleaning and use use of a units and employee disinfection respirator as Units with familiarity with protocols needed to patients on product before Storage protect from airborne iso- a pandemic or issues airborne lation pre- other emer- between uses contami- cautions gency Cannot be nants Areas with Potentially used in a Clinical con- large improved fit sterile dition volumes of surgical field requires patients on respiratory airborne protection isolation precautions Surge Facility Widespread Avert shortage Cleaning and use capacity seasonal of disposable disinfection (beds, staff, influenza filtering protocols supplies) is that persists facepiece Storage exceeded beyond respirators issues Respiratory traditional Health care between uses illness time frame workers' incidence Pandemic perception that extends influenza the institution beyond Viral is investing in epidemic hemorrhagic their safety and curve fever or well-being Atypical ill- other ness that re- airborne quires outbreak airborne isolation
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From page 177... ...
Conclusion 2: Routine Use of Reusable Elastomeric Respirators The committee concludes that reusable elastomeric respirators could be a viable option for respiratory protection programs for routine use in health care when logistic and implementation chal lenges are addressed, including education, training, cleaning, dis infection, and storage challenges. Advantages of integrating reusable elastomeric respirators into day-to-day practice and reg ular training would include the increased familiarity of staff with these respirators and the implementation and continued improve ment of policies and practices for cleaning, disinfection, and maintenance, leading to better preparedness in the event of the need for broader use during an emergency or pandemic situation.
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From page 178... ...
Conclusion 4: Health Care Needs Regarding Respiratory Protection The committee concludes that addressing the respiratory health needs of health care workers -- across their wide range of settings and jobs (including home health caregivers, rural clinic personnel, outpatient emergency medical personnel, food and custodial staff, nursing home staff, and hospital staff) -- will require the design of innovative reusable respirators and the implementation of robust respiratory protection programs.
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From page 179... ...
NEXT STEPS AND RECOMMENDATIONS 179 Need for estimates of the total costs of using reusable elastomeric respirators including costs of training, clean ing, disinfection, and maintenance and comparisons of to tal costs of using other types of respiratory protection; Paucity of education programs, training materials, and strategies for change that focus on both basic, routine use and transitions from routine to surge situations for respir atory protection; Need for harmonized and consistent guidance and stand ards by regulatory and policy-making authorities that include clear direction on the level of respiratory protec tion needed and on the stockpiling responsibilities of gov ernment and private-sector organizations; Need for collaborative efforts by health care management and workers to considerably improve the monitoring and championing of respiratory protection in clinical care across the wide range of health care settings and profes sions in routine health care and surge situations; Need for well-integrated and comprehensively evaluated implementation plans for transitioning between regular and surge use of respirators and between types of respirators; Need for established accountability policies for each fa cility's respiratory protection program that include re sponsibilities of health care leaders, including administra tors and managers, health care workers, infection preven tion and control specialists, and occupational health and safety professionals; and Incomplete information for health care facilities concern ing stockpiling expectations and the make and model of respirators stored in state and federal stockpiles. NEXT STEPS AND RECOMMENDATIONS The committee sees potential long-term value in the use of elastomeric respirators both during routine use and during public health emergencies; therefore, it has developed the following set of recommendations to promote their use and protect health care workers and, as a result, improve patient care.
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From page 180... ...
As noted earlier, the nature of health care work includes providers being responsible for multiple patients with varying health conditions and therefore needing to prevent transmission between and among patients and providers; the sudden and non-routine need for respiratory protection; the possibility of needing to address unknown and potentially lethal and highly transmissible infectious agents; and the absence of an "industry-standard" protocol ensuring that health care workers are allowed to perform their jobs only if they conform to the safety requirements associated with the job. There are currently gaps in knowledge in a number of areas, ranging from the basic science of the transmission of many airborne diseases to design and technology innovations in respirators, especially reusable elastomeric respirators, and to improved fit, degree of protection, and ease of use.
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From page 181... ...
Infection Risk Research for Hazard Assessment o Determine and better understand the relative con tribution of the routes of transmission for poten tially airborne transmissible pathogens to under pin and improve hazard assessment in health care to ensure proper respiratory protection; Cleaning and Disinfection Research o Identify and disseminate guidance and standards for cleaning and disinfecting reusable respirators (including cleaning and disinfection agents that are mycobacterial, viral, and sporicidal) without damaging the integrity of the devices and degrad ing their performance; o Develop and evaluate practical and effective clean ing, disinfection, and maintenance processes, sys tems, and equipment for reusable respirators that could be implemented for routine use and could be rapidly deployed for emergency use in health care environments; Respirator Research and Development o Develop the next generation of reusable respira tors to meet the needs of health care workers, as informed by prior research (e.g., Project BREATHE)
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From page 182... ...
during routine use across the range of health care settings and jobs;
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From page 183... ...
All these facets must come together for the successful protection of health care workers in clinical settings both during regular operations and during public health emergencies. There has been little attention paid to reusable elastomeric respirators or to exploration about how to engage the health care workforce in respiratory protection education and training.
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From page 184... ...
should adopt, implement, and evaluate a set of core competencies in respiratory protection that include re usable respirators as an integral component of new and updated respiratory protection curricula and should ensure that training and education programs, at all levels and across work settings, equip health care workers to meet those competencies; Health care employers, managers, and workers -- working with CDC, OSHA, the Joint Commission, and professional associations -- should champion the im portance of respiratory protection programs, espe cially involving the use of reusable elastomeric respirators, and support the use of new models for building a workplace safety culture, such as the use of practice champions, to normalize the use of respira tory protection;
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From page 185... ...
Recommendation 3: Harmonize Standards and Clarify Guidelines and Responsibilities The Centers for Disease Control and Prevention, including the National Institute for Occupational Safety and Health and the National Center for Immunization and Respiratory Diseases, the Occupational Safety and Health Administration, the U.S. Food and Drug Administration, staff of the Strategic National Stockpile, and state-level regulatory and stockpile entities -- in conjunction with manufacturers, standards-setting organiza tions, health care facilities, health care professional associa tions, and other relevant stakeholders -- should support the harmonization of guidance and operating procedures for the use of elastomeric respirators in the health care setting.
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From page 186... ...
CONCLUDING COMMENTS Although this report is focused on one type of respiratory protective device -- half-facepiece reusable elastomeric respirators -- the paramount issues are much broader and center on ensuring the safety and health of health care workers and the continuity of high-quality patient care. Health care has long been acknowledged as a profession with potential dangerous and life-threatening risks.
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