The National Institute for Occupational Safety and Health (NIOSH) requests input and comment on the Personal Protective Equipment (PPE) for Healthcare Workers (HCW) Action Plan, NIOSH Docket Number NIOSH-129.
The information contained in this document is still in draft form and as such should not be considered as a final statement of NIOSH policy.
NPPTL Draft Personal Protective Equipment (PPE) for Healthcare Workers (HCW) Action Plan
In 2006, the IOM COPPE determined that there is an urgent need to address the lack of preparedness regarding effective PPE for use in an influenza pandemic. Subsequently, the National Institute for Occupational Safety and Health (NIOSH) National Personal Protective Technology Laboratory (NPPTL) commissioned the Institute of Medicine (IOM) to examine issues regarding PPE for healthcare workers in the event of pandemic influenza. The IOM committee was charged with examining research directions, certification and the establishment of standards, and risk assessment issues specific to personal protective equipment for healthcare workers during an influenza pandemic.
The IOM provided three overarching conclusions and a series of recommendations for maximizing the opportunity to incorporate PPE into influenza pandemic research. The committee also provided recommendations regarding future research opportunities. The IOM’s twelve recommendations addressing the three overarching conclusions are:
Understand Influenza Transmission
- Initiate and Support a Global Influenza Research Network
Commit to Worker Safety and Appropriate Use of PPE
- Emphasize Appropriate PPE Use in Patient Care and in Healthcare Management, Accreditation, and Training
- Identify and Disseminate Best Practices for Improving PPE Compliance and Use
- Increase Research and Research Translation Efforts Relevant to PPE Compliance
Innovate and Strengthen PPE Design, Testing, and Certification
- Define Evidence-Based Performance Requirements (Prescriptive Standards) for PPE
- Adopt a Systems Approach to the Design and Development of PPE
- Increase Research on the Design and Engineering of the Next Generation of PPE
- Establish Measures to Assess and Compare the Effectiveness of PPE
- Ensure Balance and Transparency of Standards-Setting Processes
- Strengthen Pre-market Testing of PPE for Healthcare Workers
- Strengthen Post-market Evaluation of PPE for Healthcare Workers
- Coordinate Efforts and Expand Resources for Research and Approval of PPE
More than 14 million workers in the United States (approximately 10 percent of the U.S. workforce) are employed in the healthcare field. Thus, it’s important that we protect those workers on the front lines with the best available PPE and prevention methods to handle an influenza pandemic. To that end, it is imperative that a global influenza research network be established to examine the influenza transmission issues that directly affect the PPT Program. Some of the major questions that need answers are:
- What are the relevant sizes of aerosols?
- What is the infectivity of aerosols?
- Is high humidity an issue with wearing respirators?
- How does air flow exchange and ventilation affect transmission?
- and Should other than respirator PPE be certified, if so who’s responsibility is it?
NIOSH/NPPTL has the overall management responsibility for the NIOSH PPT Program and is responding to the IOM report by developing an action plan for addressing the issues and recommendations within the PPT program domain described in the report. The action plan provides both a near term and long term strategy for influenza pandemic research, development, and investigative testing for the PPT Program. The action plan addresses implementation of research recommendations in the workplace. The following steps are being taken to develop the action plan:
- Assess the IOM recommendations to identify actions within the PPT Program domain
- Review on-going and proposed PPT Program activities
- Assess the IOM recommendations to determine if existing data are available to make decisions on whether the recommendations should be implemented near or long term
- Apprise applicable organizations to disseminate actions outside the PPT Program domain.
- Solicit stakeholder input on action plan.
- Review on-going activities in NIOSH, academia, government, and industry related to influenza pandemic preparedness.
- Prioritize activities in response to recommendations within the PPT Program domain
- Determine if new initiatives for PPT Program should be managed through intra- or extra-mural processes
- Schedule project proposals into the PPT Program strategic planning process
- Develop final PPE for HCW Action Plan
- Implement PPE for HCW Action Plan
This action plan was prepared in response to the Institute of Medicine (IOM) recommendations contained in a report entitled Preparing for an Influenza Pandemic: PPE for Healthcare Workers, 2008.
Each recommendation identifies current activities in progress within the NIOSH PPT Program and subsequent activities which should be considered for both near term and long term implementation. Associated references and weblinks are provided for ongoing activities where available. Each text description is accompanied by a flow chart which provides a pictorial representation of the information described in the associated text. Associated Gantt Charts identifying anticipated timelines for conducting the activities in response to each recommendation follow the flow charts. The PPT Program ongoing and potential future activities are highlighted in yellow. Note that Recommendation #1 in the IOM Report reaches beyond the PPT Program. NIOSH is currently developing additional plans to provide a comprehensive response to that recommendation. The current response is the first effort to most effectively respond to the report and solicit stakeholder input for a more refined approach. The PPT Program Action Plan activities identified for near term implementation will be considered within the current budget constraints of the PPT Program during the fiscal year 2009 strategic planning process.
Being ready for an influenza pandemic—having the necessary resources to minimize morbidity and mortality—is the goal of ongoing global efforts in many areas of endeavor. Since healthcare workers are essential for providing patient care during a pandemic, the personal protective equipment that can protect these workers from becoming infected or from transmitting infection is a vital part of these efforts. Healthcare worker safety is essential for patient safety and patient care. Being prepared for an influenza pandemic places a priority on protecting the healthcare workforce.
This draft action plan was developed by:
- analyzing the IOM recommendations to identify approaches to address the recommendations;
- reviewing on-going and proposed NPPTL research, certification, and policy and standards activities to identify relevant ongoing activities; and
- reviewing on-going research in NIOSH, academia, government, and industry related to the overarching conclusions to Understand Influenza Transmission, Commit to Worker Safety and Appropriate Use of PPE and Innovate and Strengthen PPE Design, Testing, and Certification
The draft action plan and appendices for review and comment are:
Timeline to finalize the action plan is described as follows:
- Detailed draft action plan posted to NPPTL website (February 25 2008)
- Open docket to solicit comments for 30 days (Feb 25 - April 1 2008)
- Revise action plan based on comments received (May 2008)
The final action plan will be used to prioritize and select future NPPTL research projects including funding, staffing, and upgrading laboratory capabilities.
Time Frame for Review
Comments will be accepted until 5:00 p.m. EDT on June 1, 2008.
To submit comments regarding this draft publication, please use
one of these options:
- Send comments by email.
- Fax comments to the NIOSH Docket Office: 513-533-8285
- Send by Mail to:
NIOSH Mailstop: C-34
Robert A. Taft Lab.
4676 Columbia Parkway
Cincinnati, Ohio 45226
NIOSH Draft Documents for Public Review
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