PPE and voluntary consensus standards. A Final Rule, issued in November 2007, requires employers to provide PPE at no cost to their employees; this change took the burden of responsibility off the employees, who in some cases had been paying for their own protective equipment (29 Code of Federal Regulations [CFR] 1910.132; OSHA, 2007). In September 2009, a Final Rule was promulgated to address various revisions of the voluntary consensus standards as they applied to several types of PPE, including eye and face protection (29 CFR 1910.133), head protection (29 CFR 1910.135), and foot protection (29 CFR 1910.136; OSHA, 2009). Because many consensus standards are updated on a regular basis, the new OSHA regulations state that the employer needs to supply PPE that meets the current voluntary consensus standard or either of the past two versions of that standard; thus employers do not have to purchase new PPE every time a consensus standard is revised.

In October 2009, the National Institute for Occupational Safety and Health (NIOSH) proposed total inward leakage (TIL) requirements for the certification of negative-pressure, tight-fitting respirators. The new regulation would require that half-facepiece, air-purifying respirators (including filtering facepiece respirators such as the N95 respirator) be fit tested to an anthropometrically selected panel of wearers. Respirators would need to be able to achieve an acceptable fit to a wide range of faces. Two public meetings have been held, and the docket for public comments closed in September 2010 (NIOSH, 2010a). NIOSH will evaluate the comments received and may then release a final standard. The goal is to improve the fit of respirators.

In 2009, California became the first state in the nation to issue a standard requiring employers to protect healthcare personnel from influenza and other viral respiratory diseases when it promulgated its aerosol-transmissible diseases standard (California Code of Regulations, 2010). This standard uses Centers for Disease Control and Prevention (CDC) guidelines and terminology to classify whether an aerosol-transmissible disease requires droplet precautions (use of face masks is permitted) or requires aerosol precautions (respiratory protection is required using N95s at a minimum, and where aerosol-generating procedures are performed, a powered air-purifying respirator [PAPR] or greater level of protection is required) (Siegel et al., 2007). Thus, by adopting the CDC guidelines, healthcare employers in California would, for example, protect personnel against seasonal influenza using face masks, while exposures to measles virus would require respirators (N95s or greater). For novel or unknown pathogens (e.g., the 2009 H1N1 pandemic influenza

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