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Introduction

For more than 100 years the U.S. federal government has worked to improve respiratory safety and protection through research and certification programs. Beginning in 1911 with a program in the Department of the Interior’s United States Bureau of Mines, these efforts have expanded to include multiple federal agencies and to provide protections to many types of workers and their environments.¹ As part of these efforts, since 2005 the National Institute for Occupational Safety and Health’s (NIOSH’s) National Personal Protective Technology Laboratory (NPPTL) has sponsored the National Academies of Sciences, Engineering, and Medicine’s (the National Academies’) Standing Committee on Personal Protective Equipment for Workplace Safety and Health.^2,3 Recently, new concerns for respiratory health and safety have emerged that are not readily addressed by the exist-

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¹ More information about the federal government’s history with respiratory protection is available at https://www.cdc.gov/niosh/npptl/Respiratory-Protection-history.html (accessed October 8, 2020).

² The Standing Committee on Personal Protective Equipment for Workplace Safety and Health at the National Academies of Sciences, Engineering, and Medicine provides a forum for discussing scientific and technical issues relevant to the development, certification, deployment, and use of personal protective equipment (PPE), PPE standards, and related systems used to ensure workplace safety and health.

³ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

ing systems and processes for ensuring respiratory protection for certain user groups. For instance, wildland fires, air pollution, and infectious diseases are growing threats to the respiratory safety of many nontraditional workers⁴ and members of the general public. Numerous challenges are at play with respect to the use of respiratory protective devices (RPDs) in these new environments, their conformity assessment (CA), and the processes used to evaluate them. Additionally, unanswered research questions and the need to communicate effectively about these concerns to nontraditional workers, their employers, and the general public are emerging as these groups need to increasingly use RPDs. On August 4–5, 2020, the National Academies convened a virtual workshop, Current Issues in the Assessment of Respiratory Protective Devices: Nontraditional Workers and Public Use. The workshop was sponsored by NPPTL to address approaches to the respirator approval process in the current landscape for both occupational and non-occupational use of respirators. Additionally, the workshop was tasked with considering gaps in respiratory protection for outdoor workers and the general public. (See Appendix A for the workshop Statement of Task.)

WORKSHOP OBJECTIVES

The workshop had six sessions held virtually over 2 days and featured invited presentations and discussions that focused on:

• Reviewing lessons learned over the past 100 years of respiratory protection and how these can be applied to the assessment of RPDs moving forward;
• Exploring current respiratory protection needs and risks for nontraditional worker groups and the public;
• Reviewing current practices of the NIOSH respirator approval program and CA processes for respirators and identifying opportunities and gaps;
• Exploring conformity assessment approaches used in other countries, by third-party organizations, and in private industry and discussing the risks and benefits of these approaches in the context of RPD use by nontraditional workers and the public;
• Examining whether the respiratory protection needs of underserved groups, such as nontraditional workers and the public, are served

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⁴ The planning committee and some workshop participants used the term “nontraditional workers” to describe those occupational users who perform their job functions outside of a formal respiratory protection program. The term “nontraditional worker” is used throughout the proceedings, but in some instances presenters may use other terms to refer to this or similar occupational user groups, such as contingent workers, informal workers, nontraditional employees, etc.

• by current standards and assessment programs and identifying opportunities and research gaps; and
• Exploring research gaps in understanding the respiratory protection needs of nontraditional workers as well as opportunities to enhance the communication of respiratory protection guidance to users and other stakeholders.

Because the workshop focused on two distinct types of potential occupational and non-occupational users of RPDs—nontraditional workers and the general public—the individual workshop sessions and presentations were targeted to the particular needs and requirements of these two different user groups. Sessions specific to each group were identified as such, and presenters were asked to tailor their remarks to the user group of focus.

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or develop recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning and convening the workshop. In accordance with institutional guidelines, the proceedings of the workshop were prepared by a designated rapporteur as a factual summary of what occurred at the workshop. The views captured in the proceedings are those of individual workshop participants and do not necessarily represent the views held by the workshop participants, planning committee, or the National Academies.⁵

TERMINOLOGY

The planning committee and some workshop participants used the term “nontraditional workers” to describe those occupational users who perform their job functions outside of a formal respiratory protection program. The term “nontraditional worker” is used throughout the proceedings but in some instances, presenters may use other terms to refer to this or similar occupational user groups, such as contingent workers, informal workers, nontraditional employees, etc.

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⁵ In order to clarify terminology in this publication: masks, face coverings, facial coverings, and respirators are distinct terms with distinct meanings but their use in this proceedings depends on the speaker’s choices. Every attempt has been made to limit the term respirators to a tight-fitting device that protects the user from inhaling airborne contaminants and masks to mean coverings that are loose, unfitted devices that cover the nose and the mouth of the user and provide protection for the environment from the user’s cough and exhaled secretions. Respiratory protective devices (RPDs) include respirators as well as masks, face coverings, and facial coverings (Johnson, 2020; NASEM, 2019).

Masks, face coverings, facial coverings, and respirators are distinct terms with distinct meanings but their use in this publication depends on the speaker’s choices. Every attempt has been made to limit the term respirators to a tight fitting device that protects the user from inhaling airborne contaminants, and masks to mean coverings that are loose, unfitted devices that cover the nose and the mouth of the user and provide protection for the environment from the user’s cough and exhaled secretions. RPDs include respirators as well as masks, face coverings, and facial coverings (Johnson, 2020; NASEM, 2019).

ORGANIZATION OF THE PROCEEDINGS

The proceedings of this workshop are organized into seven chapters. Chapter 2 summarizes the discussion of the workshop’s opening panel, which explored how the assessment and approval of RPDs have evolved over the past century to meet the needs of occupational users. Chapter 3 focuses on respiratory risks and user requirements for nontraditional workers, while Chapter 4 focuses on respiratory risks and user requirements for the public. Chapters 5 and 6 examine assessment pathways for RPDs for occupational use by nontraditional workers and non-occupational use, respectively. Chapter 6 also provides more background on devices, fabrics, and standards. Chapter 7 explores gaps in research and communication that relate to the assessment of respiratory protection devices for nontraditional workers and public use.

OPENING REMARKS

Maryann D’Alessandro, the director of NPPTL at NIOSH, explained that NIOSH and NPPTL got the idea for the workshop in 2019 after working for several years with the Department of State, the Environmental Protection Agency, and public safety stakeholders on the use of respiratory protection to ward off hazards associated with smoke exposures from wildland fire. Smoke exposures are one of multiple respiratory hazards confronted by contingent workers and the public. However, there is currently no well-defined approach for protecting against the respiratory hazards faced by these populations. There are clearly established responsibilities and pathways related to the testing and approval of RPDs for occupational uses, but clarity is needed concerning which parties should hold responsibilities related to the assessment and approval of RPDs and other face coverings for use by nontraditional workers and the general public. In requesting the National Academies to develop this workshop, NIOSH and NPPTL sought to identify key concepts that could help to better inform respiratory protection policy and identify science gaps for the contingent workforce and

the general public. The workshop also served as an information-gathering source for a soon-to-be-launched consensus study that will explore similar issues over the next 12–18 months, with the aim of providing recommendations on a path forward for the nation.

Melissa McDiarmid, the chair of the workshop planning committee and a professor at the University of Maryland School of Medicine, said that the planning for this workshop began before the beginning of the coronavirus disease 2019 (COVID-19) pandemic. As such, the COVID-19 pandemic was not intended to be a focus of the workshop, nor was it included as a defined topic in the workshop agenda. However, McDiarmid noted that COVID-19 would be discussed throughout the workshop sessions as it is a current issue of great relevance to the workshop’s objectives, particularly in terms of the use of face coverings by workers and the public and in addressing research and communication gaps in the field of respiratory protection.

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