With adequate time and planning, stockpiling or ramping up production of respirators and medical masks or both would ensure a plentiful supply for all those who need them, but with limited resources and time, supplies are likely to be insufficient. Thus, reality may require that disposable N95 filtering facepiece respirators and medical masks be pushed beyond their approved uses in the hope that they will provide some level of protection beyond their intended limits of use. Moreover, individuals with no access to respirators or masks, even disposables, may feel driven to invent their own respiratory protection measures—for example, they may don woven masks not approved for medical uses in the United States or use household items such as towels or sheets.

Based on the assumption that efforts to produce and stockpile sufficient supplies of disposable masks and/or respirators may fall short in the event of a pandemic, in January 2006 the Department of Health and Human Services (DHHS) asked the Institute of Medicine (IOM) to convene a committee to conduct a 90-day assessment of

  • what measures can be taken that would permit the reuse of disposable N95 respirators in healthcare settings, and

  • what is known about the need for, and development of, reusable facemasks for healthcare providers and the general public.

(The full language of the charge can be found in Box 1-2 in Chapter 1.)

The committee was asked to focus on N95 filtering facepiece respirators and medical masks because they would be affordable, widely available, and likely to be used in the event of an influenza pandemic. The committee was also asked to assess whether there are any cost-effective alternatives to N95 filtering facepiece respirators and medical masks that could provide adequate levels of protection and could be used against the influenza virus during a pandemic.

In the short time available, the committee reviewed the published literature on respirator and mask effectiveness, infectious disease control, and occupational health and industrial hygiene and communicated with representatives of industry, the public health community, government agencies, regulators, and the international community. These efforts revealed that data are severely limited in some critical areas, leading the committee to rely on its collective judgment about what would constitute responsible and safe reuse of N95 respirators or medical masks.

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