Reusable Elastomeric
Respirators in Health Care
Considerations for Routine and Surge Use
Committee on the Use of Elastomeric Respirators in Health Care
Linda Hawes Clever, Bonnie M. E. Rogers,
Olivia C. Yost, and Catharyn T. Liverman, Editors
Board on Health Sciences Policy
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by Contract #200-2011-38807 (Task Order 2) between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48515-9
International Standard Book Number-10: 0-309-48515-0
Digital Object Identifier: https://doi.org/10.17226/25275
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Reusable elastomeric respirators in health care: Considerations for routine and surge use. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25275.
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COMMITTEE ON THE USE OF ELASTOMERIC RESPIRATORS IN HEALTH CARE
LINDA HAWES CLEVER (Co-Chair), California Pacific Medical Center
M. E. BONNIE ROGERS (Co-Chair), University of North Carolina Occupational Safety and Health Education Research Center
GLORIA ADDO-AYENSU, Fairfax County Department of Health
GIO J. BARACCO, University of Miami Miller School of Medicine and Miami Veterans Affairs Healthcare System
JIM CHANG, University of Maryland Medical Center
CHRISTOPHER FRIESE, University of Michigan School of Nursing
ROBERT HARRISON, University of California, San Francisco, School of Medicine
SUNDARESAN JAYARAMAN, Georgia Institute of Technology
JAMES S. JOHNSON, JSJ and Associates
BRUCE LIPPY, The Center for Construction Research and Training
ALLISON MCGEER, Mount Sinai Hospital and University of Toronto
ANN-CHRISTINE NYQUIST, University of Colorado School of Medicine
MIKE SCHMOLDT, Argonne National Laboratory
SKIP SKIVINGTON, Kaiser Permanente
PATRICIA STONE, Columbia University School of Nursing
TENER GOODWIN VEENEMA, Johns Hopkins University
Study Staff
CATHARYN T. LIVERMAN, Study Director
OLIVIA C. YOST, Associate Program Officer
KATIE LAWALL, Senior Program Assistant (through July 2018)
JUDY ESTEP, Program Associate (from July 2018)
DANIEL BEARSS, Senior Research Librarian
ANDREW M. POPE, Director, Board on Health Sciences Policy
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
MARY T. BESSESEN, University of Colorado Denver
HOWARD J. COHEN, Consultant
BARBARA DEBAUN, Cynosure Health
TRISH PERL-DELISLE, UT Southwestern Medical Center
ROBERT M. ENINGER, Air Force Institute of Technology
RACHAEL JONES, University of Illinois Chicago
WILLIAM H. KOJOLA, AFL-CIO (retired)
SUZET M. MCKINNEY, Illinois Medical District Commission
JEFFREY C. NESBITT, Mayo Clinic
TERRI REBMANN, Saint Louis University
MARK SHIRLEY, Sutter Health
PRITISH K. TOSH, Mayo Clinic
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by ELAINE L. LARSON,
Columbia University, and LINDA A. MCCAULEY, Emory University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
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Boxes, Figures, and Tables
BOXES
1-2 Historical Context: Diseases of Workers
2-1 Case Study: Respirator Use by an International Construction Firm
2-2 Case Study: Respirator Use by a National Remediation Contractor
2-3 Case Study: Respirator Use at the World Trade Center Cleanup
2-4 Case Study: Respirator Use in the Nuclear Industry
2-5 Description of Protection Factor Studies
2-6 OSHA Procedures for Cleaning Respirators
3-1 Health Care Worker Competencies in Respiratory Protection
3-2 Example of Stockpiling Needs and Comparative Costs for a Single High-Exposure-Risk Employee
3-3 Kaiser Permanente’s Experience with Stockpiled Respirators During the 2009 H1N1 Epidemic
FIGURES
1-1 Major types of air-purifying respirators currently used in health care
2-1 Modern reusable elastomeric respirator
2-2 Reusable elastomeric respirator examples
2-3 Diagram of a half-facepiece reusable elastomeric respirator
2-4 Overview of respirator use in industry
3-1 Use of elastomeric respirators in health care: viewpoints of stakeholders
4-1 A structured approach to evidence-based performance requirements for health care respirators
4-2 Comfort to compliance: factors influencing the comfort of elastomeric respirators
4-3 CleanSpace Ultra powered air-purifying respirator
4-4 FluView weekly influenza surveillance report: week ending May 19, 2018
TABLES
S-1 Routine and Surge Use of Reusable Elastomeric Respirators
1-1 Health Care Workers, Location of Employment
1-2 Comparison of Medical Masks and Respirators
1-4 Efficiency Ratings for Respirator Filters
1-6 Strengths and Limitations of Powered Air-Purifying Respirators for Use in Health Care
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