Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A

A Letter Report

Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A

Board on Health Sciences Policy

Catharyn T. Liverman, Tracy A. Harris, M. E. Bonnie Rogers, and Kenneth I. Shine, Editors

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A A Letter Report Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A Board on Health Sciences Policy Catharyn T. Liverman, Tracy A. Harris, M. E. Bonnie Rogers, and Kenneth I. Shine, Editors

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was requested by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration and supported by Award No. 200-2005-13434, T.O. #19 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine). 2009. Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A: A letter report. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON RESPIRATORY PROTECTION FOR HEALTHCARE WORKERS IN THE WORKPLACE AGAINST NOVEL H1N1 INFLUENZA A KENNETH I. SHINE (Chair), University of Texas, Austin M. E. BONNIE ROGERS (Vice Chair), University of North Carolina, Chapel Hill GLORIA ADDO-AYENSU, Fairfax County Department of Health, Virginia HOWARD J. COHEN, Consultant, Guilford, Connecticut LEWIS R. GOLDFRANK, New York University School of Medicine SUNDARESAN JAYARAMAN, Georgia Institute of Technology, Atlanta WILLIAM H. KOJOLA, American Federation of Labor and Congress of Industrial Organizations, Washington, DC RAINA MacINTYRE, University of New South Wales School of Public Health and Community Medicine, Sydney, Australia MARK NICAS, University of California, Berkeley PETER PALESE, Mount Sinai School of Medicine, New York TRISH M. PERL, Johns Hopkins University School of Medicine, Baltimore, Maryland TIA POWELL, Montefiore-Einstein Center for Bioethics, Bronx CAROL RAPHAEL, Visiting Nurse Service of New York Study Staff TRACY A. HARRIS, Study Co-Director CATHY T. LIVERMAN, Study Co-Director ANDREW M. POPE, Board Director, Health Sciences Policy BRUCE M. ALTEVOGT, Senior Program Officer SARAH L. HANSON, Associate Program Officer CASSANDRA CACACE, Research Assistant JUDY ESTEP, Program Associate v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets in- stitutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Lisa Brosseau, University of Minnesota Elizabeth Bryce, Vancouver General Hospital Frederick M. Burkle, Jr., Johns Hopkins University Ruth Carrico, University of Louisville Carrie Dorsey, University of Maryland Elaine L. Larson, Columbia University Jean Patterson, Southwest Foundation for Biomedical Research John Schaefer, Johns Hopkins University Peg Seminario, AFL-CIO Bruce Tatarchuk, Auburn University Lawrence M. Wein, Stanford University Douglas B. White, University of Pittsburgh Medical Center Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the con- clusions or recommendations, nor did they see the final draft of the vii

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viii REVIEWERS report before its release. The review of this report was overseen by Donald Burke, University of Pittsburgh and Fred Murphy, The University of Texas Medical Branch at Galveston. Appointed by the National Research Council and Institute of Medicine, they were respon- sible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.