The committee does not distinguish between use by healthcare workers or by the public but recognizes that, in general, the risk of exposure is likely to be significantly higher among healthcare workers. The committee does note that the Occupational Safety and Health Administration (OSHA) requires employers of healthcare workers to have a respiratory protection program in place that provides greater opportunities for proper training in the continued use, disposal, and decontamination of medical masks and respirators. The committee also recognizes that in the event of pandemic influenza, many sick individuals will be treated at home; thus, caregivers and other family members will be in close proximity to infected individuals and will face much the same risks of exposure as those experienced by healthcare workers. The committee also notes that use of some respiratory protection may be limited to adults with normal lung function; children, those with underlying breathing difficulties, and those who are otherwise difficult to fit (because of facial hair or facial size) may not be able to wear respiratory protection.

EXISTING RECOMMENDATIONS AND GUIDANCE REGARDING RESPIRATOR OR MEDICAL MASK USE

Several public health agencies have issued guidance and recommendations for respiratory protection in the event of an influenza pandemic, primarily the Centers for Disease Control and Prevention (CDC) in the United States and the World Health Organization (WHO). Various agencies have also issued guidance specific to the use of respiratory protection to control the transmission of Severe Acute Respiratory Syndrome (SARS) and tuberculosis.

In 2005, CDC issued recommendations for the appropriate use of medical masks as part of a group of influenza control strategies in healthcare settings (CDC, 2005b). Although CDC notes that masks are not usually recommended in non-healthcare settings, its guidance discusses other strategies for limiting the spread of influenza in the community. OSHA’s Guidance for Medical Workers That Transport/Treat Avian Flu Patients states that all patients in a healthcare setting with fever and respiratory symptoms should be managed according to the CDC recommendations (OSHA, 2006).

In healthcare settings during periods of increased respiratory infection activity in the community, CDC recommends that patients with symptoms of respiratory illness be offered medical masks as part of a respiratory



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