healthcare workers about what PPE is critical and what level of protection this equipment will provide in a pandemic.

Prior to the 1980s, the use of healthcare PPE was largely confined to surgical settings and was primarily intended to protect patients rather than healthcare workers. Although infectious exposures to healthcare workers had long been recognized, with the emergence of HIV/AIDS and the resurgence of tuberculosis in the 1980s, emphasis was refocused on PPE for the protection of healthcare workers in all settings. Standard infection control precautions, advanced by the Centers for Disease Control and Prevention (CDC) in the late 1980s, first defined the spectrum of barrier precautions for the protection of healthcare workers (CDC, 1988). The Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard, finalized in 1991, made these protections mandatory (OSHA, 1991). Most recently, the outbreaks of severe acute respiratory syndrome (SARS) in 2003 have underscored the importance of protecting healthcare workers from infectious agents. The surge capacity that will be required to reduce mortality from a pandemic cannot be met if healthcare workers are themselves ill or are absent due to concerns about PPE efficacy. The increased emphasis on healthcare PPE and the related challenges that are anticipated during an influenza pandemic necessitate prompt attention to ensuring the safety and efficacy of PPE products and their use.

In 2000, the Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System provided a call to action for building safer healthcare systems and raising the bar for patient safety. In recent years, many healthcare systems have begun extensive efforts to improve the patient safety infrastructure by combating medication and other medical errors as well as incorporating information technology into their management structures. The increased emphasis on patient safety is a strong foundation that should be coupled with an equally strong emphasis on the safety of healthcare workers, including the use of PPE. Ensuring the safety of the healthcare workforce will have additive benefits in reducing the risk of disease transmission to patients and preserving the quality of patient care.

In 2005, the National Personal Protective Technology Laboratory (NPPTL) at the National Institute for Occupational Safety and Health (NIOSH) asked the IOM to form a standing committee to provide strategic guidance in addressing PPE issues for a wide range of workers. One issue that the IOM standing committee and NPPTL deemed of high importance is the topic of this report—enhancing the PPE for healthcare



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