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

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

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

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2019 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

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.

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:

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.

Contents

SUMMARY

1 INTRODUCTION

2 ELASTOMERIC RESPIRATORS

3 IMPLEMENTING REUSABLE ELASTOMERIC RESPIRATORS IN HEALTH CARE SETTINGS: ROUTINE AND SURGE USE

4 RESEARCH AND DEVELOPMENT

5 NEXT STEPS AND RECOMMENDATIONS

APPENDIXES

A MEETING AGENDAS

B COMMITTEE BIOGRAPHICAL SKETCHES

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Boxes, Figures, and Tables

BOXES

1-1 Statement of Task

1-2 Historical Context: Diseases of Workers

1-3 Categorizing Respirators

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

3-4 Key Components of Safety Culture Change

4-1 Phases of Project BREATHE

FIGURES

1-1 Major types of air-purifying respirators currently used in health care

1-2 Hierarchy of controls

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

1-3 Hierarchy of Controls in the Context of the Treatment of a Patient with an Airborne Transmissible Disease

1-4 Efficiency Ratings for Respirator Filters

1-5 Overview of the Strengths and Limitations of Disposable Filtering Facepiece Respirators for Use in Health Care

1-6 Strengths and Limitations of Powered Air-Purifying Respirators for Use in Health Care

2-1 Examples of Jobs and Contaminants That Commonly Involve the Use of Reusable Elastomeric Respirators

2-2 Recent Studies on the Performance of Half-Facepiece Reusable Elastomeric Respirators

2-3 Assigned Protection Factors

2-4 Overview of Research on the Cleaning and Disinfection of Reusable Elastomeric Respirators in Health Care

2-5 Examples of Manufacturer Instructions for the Cleaning and Disinfection of Half-Facepiece Reusable Elastomeric Respirators

2-6 Benefits and Limitations of the Use of Reusable Elastomeric Respirators at the University of Maryland Medical Center

2-7 Benefits and Limitations of the Use of Reusable Elastomeric Respirators at the Texas Center for Infectious Disease

3-1 Annual RPD Pandemic Stockpiling Costs for a Population of 1 Million, per Strategy

3-2 Overview of 2009–2010 H1N1 Policies and Practices Regarding Personal Protective Equipment and H1N1 Influenza

4-1 Project BREATHE’s Major Categories and Desirable Performance Objectives for Health Care Respirators and Respiratory Protection Programs

5-1 Routine and Surge Use of Reusable Elastomeric Respirators

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