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SEASONAL INFLUENZA (FLU) IN THE WORKPLACE

Man Sneezing into tissue

NIOSH Activities: Respiratory Protection Research

The following NIOSH research projects focus on various issues which affect the use of filtering facepiece respirators (FFR).

Reusability of Filtering Facepiece Respirators

General Description: This project focuses on the reusability of FFR by conducting laboratory studies to understand: 1) the efficacy of decontamination methods; 2) the impact of decontamination methods on FFR performance; and 3) the risks associated with handling a respirator contaminated with virus.

Relevance to worker safety and health: Findings from this research may be used by the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) to develop scientific recommendations on personal respiratory protection for healthcare workers, emergency responders, and the general public. These studies may also be used by national and international standards development organizations to support new test methods.

Key Findings: Key findings of this project are found in the following 16 peer-reviewed publications:

Status: This was project was completed in FY12.

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts12/TRB_INH_939ZUNL_FY12_QC.html

Point of Contact: CDC-INFO

Metabolic Evaluation of N95 Respirator Use with Surgical Masks

General Description: The Institute of Medicine (IOM) has recommended the possibility of extending the duration of individual N95 respirators by covering the respirator with a surgical mask. This investigation compares using an N95 respirator with and without a surgical mask cover, and the potential effects on the wearer of the surgical mask overlay. These potential effects will be assessed using an automated breathing and metabolic simulator (ABMS) in lieu of human subjects. Depending on the results of this study, future investigations could include the reconfiguration of the ABMS to mimic special needs populations.

Relevance to Worker Safety and Health: The IOM recommendation, which responded to concerns that the availability of N95 particulate filtering respirators may be insufficient for the duration of an influenza pandemic, was made in the absence of scientific evidence that this practice would have no important adverse effect on the wearer.

Key Findings: Not yet available.

Status: This project is scheduled through September 2011.

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts10/Z6PV_FY10_QC.htm

Point of Contact: CDC-INFO

N95 and P100 Total Inward Leakage (TIL) testing

General Description: Total Inward Leakage (TIL) accounts for all leakage paths by which particles may enter the wearer's breathing zone. These paths include penetration through the filter, the face piece seal to the face, and any other leakage paths through seams or points of component connection. This project evaluates the relative effectiveness of N95 and P100 respirators equipped with the same face piece type (e.g. half-mask, full face piece) when worn on fit tested subjects. Testing is conducted using multiple subjects, multiple respirator donnings, with fit testing performed using at least two size ranges of challenge particulates.

Relevance to Worker Safety and Health: This project will contribute scientific data to demonstrate the relative contributions of filter efficiency and face seal fit to the overall protection provided by particulate respirators. Dissemination of information on the importance of face seal fit for the proper selection of particulate filter respirators will be beneficial to employers and respirator users who are faced with making sure that they use properly fitting respirators that provide an expected level of protection.

Key Findings: Data analysis and review is underway

Status:This project is scheduled for completion by October 1, 2012

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts11/ZBFP_FY11_QC.htm

Point of Contact: CDC-INFO;

The Impact of Respirator Use on C02 Levels and 02 Saturation

General Description: This project investigates the possibility of increased CO2 retention and decreased O2 saturation sufficient to reduce the performance of the wearer with long-term use of filtering face piece respirators (FFR). Healthcare workers who wear FFR to protect them from influenza may end up not breathing in enough oxygen and re-breathing too much carbon dioxide. This study evaluates the magnitude of these effects in subjects exercising on a treadmill at a predetermined work load (exercise level).

Relevance to Worker Safety and Health: Healthcare workers who wear FFR to protect them from influenza may encounter CO2 and O2 issues as a result of their respirator use. The CO2 and O2 issues may be further exaggerated if a surgical facemask is worn as an overlay to prolong the useful life of the FFR. Results from this study can be used by respirator manufacturers to improve their products and by consensus standards organizations to develop guidance documents with appropriate performance levels.

Key Findings: Key findings of this project are found in the following peer-reviewed NIOSH publications:

Status: Complete

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts11/ZBFS_FY11_QC.htm

Point of Contact: CDC-INFO

Respirator and Surgical Mask Efficacy from Cough Aerosols

General Description: There is a lack of scientific evidence of the efficacy of surgical masks and respirators in preventing the transmission of influenza to healthcare workers from patient coughs. As a result, there is considerable controversy over the level and type of protection needed to adequately protect workers from this potential source of infection. The purpose of this project is to measure how well surgical masks and disposable filtering facepiece respirators (FFR) protect healthcare workers from potentially infectious aerosols produced by patients during coughing, A cough aerosol exposure simulation system (cough simulator) produces a simulated aerosol-laden "cough" through a standard head form ("the coughing head form"). A second head form ("the breathing head form") outfitted with a surgical mask or filtering facepiece respirator (e.g. N95) is connected to a breathing machine to simulate the inhalation and exhalation of a healthcare worker. The coughing and breathing head forms are placed in a test chamber to simulate the cough of a patient and the respiration of a nearby healthcare worker.

Relevance to worker safety and health: This project will provide enhanced scientific knowledge to develop appropriate workplace recommendations for healthcare workers based on the measured amount of the "cough" aerosol inhaled by the breathing head form with or without a surgical mask or respirator.

Key Findings: Not yet available.

Status: This four-year project is scheduled through September 2011.

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts10/ZBFW_FY10_QC.htm

Point of Contact: CDC-INFO

Better Respirator Equipment Using Advanced Technologies for Healthcare Employees (Project BREATHE)

General Description:Healthcare workers may be required to wear respirators for extended periods of time to protect themselves from the threat of some infectious diseases. Furthermore, field studies have reported that healthcare worker compliance with recommended respiratory protection practices is often poor. Causes of poor compliance are complex, but factors related to the design of the respirator such as discomfort and lack of usability are commonly reported by end-users. To improve respirator compliance, Project BREATHE was initiated as a collaboration between National Institute for Occupational Safety and Health, the Department of Veterans Affairs, and other partners to encourage the development of better respirators for healthcare workers. Key phases in the project include: (1) participation in a Project BREATHE inter-agency working group to identify the ideal characteristics of a respirator specific for healthcare workers; (2) development of clinically-validated respirator test methods; (3) promulgation of a voluntary consensus standard for a healthcare worker specific respirator; and (4) development and evaluation of prototype respirator designs that incorporate novel features of benefit to healthcare workers.

Relevance to worker safety and health: Project BREATHE seeks to encourage the development of more comfortable and usable respirators for healthcare workers, with the ultimate goal of increasing compliance with recommended respirator policies and procedures.

Key Findings: Key findings of this project are found in the following peer-reviewed NIOSH publications:

Status: This project is scheduled through September 2015. In addition to the 14 published papers listed above under "Key Findings," three additional manuscripts have been written and are currently under review for publication.

Links: http://www.cdc.gov/niosh/nas/ppt/QUADCharts12/TRB_INH_939ZUNK_FY12_QC.html
http://www.publichealth.va.gov/docs/cohic/project-breathe-report-2009.pdf [PDF - 538 KB]

Point of Contact: RShaffer@cdc.gov

Development of Computer-Aided Face-Fit Evaluation Methods

General Description: The purpose of this project is to develop computer-aided face-fit evaluation methods to better assess and improve the fit of respirators, thereby reducing exposure to airborne occupational infectious agents through improved respiratory protection. Results of anthropometric studies are used to develop specifications for the development of head forms and fit test panels that encompass facial dimensions representative of the vast majority of workers.

Relevance to Worker Safety and Health: Standards development organizations, such as ISO, ANSI, FDA and NIOSH may incorporate the knowledge gained and the products developed in this research into their standards, thereby improving respirator fit and protection for workers.

Key Findings: Key findings of this project are found in the following peer-reviewed NIOSH publications:

Status: This twelve-year project is scheduled through September 2013. In addition to the published papers listed above under "Key Findings," one additional manuscript has been written and is currently under review for publication.

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts11/PP09_FY11_QC.htm

Point of Contact: CDC-INFO

Respiratory Protection Effectiveness Clinical Trial (ResPECT) - Effectiveness Comparison of N95 Filtering Facepiece Respirators and Surgical Masks Against Influenza

General Description: The ResPECT study is a collaboration between National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control’s Office of Infectious Diseases (CDC/OID), Department of Veterans Affairs (VA), and Johns Hopkins University (JHU). The project aims to answer a key question about personal protective equipment (PPE) use: How well do N95 filtering facepiece respirators (FFRs) protect healthcare workers (HCWs) in the outpatient setting against influenza, influenza-like illness (ILI), acute respiratory illness (ARI) and other respiratory illnesses, as compared to surgical masks (SMs)?

Relevance to worker safety and health: Control strategies are critical in limiting the transmission of respiratory viruses such as influenza. Among non-pharmaceutical interventions, there is intense interest in the use of SMs and NIOSH-certified N95 FFRs when faced with seasonal influenza, epidemic or pandemic respiratory illness. However, their relative protective effect in clinical settings, especially in the outpatient setting, is unclear. The role of healthcare-associated transmission in the 2003 SARS outbreak stimulated a series of evaluations examining which interventions were critical in decreasing spread of this respiratory virus among HCWs. While data emerged supporting the use of respirators for procedures with a risk of extensive exposure to respiratory secretions, the need for respiratory protection outside of these settings was not adequately studied. Studies from epidemic respiratory virus season in the healthcare setting are missing and recommendations for respiratory protection among HCWs are controversial. This study is designed to provide additional research data that is needed to guide planning activities and policy makers to enable public health groups and healthcare delivery organizations to provide appropriate protection for HCWs in the event of an influenza pandemic or other infectious diseases epidemic.

Key Findings: None to date.

Status: A pilot study was conducted at John Hopkins Health System in Baltimore, Maryland during the 2010-2011 influenza season. Subjects enrolled at 4 locations (6 clusters) in the pilot study and were divided into two arms: FFR and SM. A total of 110 subjects completed the study, split evenly between the two arms. Weekly and symptomatic nasal swab samples are being analyzed for the presence of 17 respiratory viruses. The study was expanded to the VA-New York Harbor Healthcare System and Denver Health / U. of Colorado for the 2011-2012 influenza season. Data collection began in January 2012, with 657 subjects enrolled in 53 clusters across the 3 sites. Additional sites in other regions of the country are planned for the 2012-2013 influenza season. Current plans are to continue the study for several more years at multiple locations until enough data are collected to meet study objectives (sufficient power to detect a 25% reduction in lab confirmed influenza among subjects in the FFR arm vs. the SM mask arm).

Links: http://clinicaltrials.gov/ct2/show/NCT01249625?term=NCT01249625&rank=1
http://www.publichealth.va.gov/about/cohic/projects.asp#respiratory

Point of Contact: CDC-INFO

Why Hospital Staff Catch the Flu: Assessing Modes of Transmission

General Description: The goal of this project is to conduct a series of laboratory and field studies to improve understanding of the relative contributions of the direct-contact (e.g., fomite), inhalation, inspiration, and direct-spray transmission routes of influenza in healthcare settings. Laboratory studies will examine the relationship of airborne influenza concentration to levels of personal protective equipment (PPE) contamination to determine whether the PPE can be used as semi-quantitative “personal bioaerosol samplers”. Field studies will be done at Johns Hopkins University (JHU) to measure influenza exposures during patient care and to correlate that information with health outcomes from the companion Respiratory Protection Effectiveness Clinical Trial (ResPECT).

Relevance to worker safety and health: Information from this study will improve our understanding of the relative importance of the modes of influenza transmission. This information will be used by government agencies to address issues of appropriate protection for the ~14 million HCWs in the US. The data may also be beneficial to public health officials in selecting non-pharmaceutical interventions to reduce the spread of seasonal and epidemic influenza among the general public.

Assessing the contamination of PPE of HCWs exposed to infectious patients will assist in discerning the modes of transmission of influenza, which in turn will assist in developing guidance for proper intervention and control. Moreover, assessing the level of PPE contamination collected in the field during flu season, for which no published data exists, will assist in the risk assessment associated with PPE reuse and cleaning during pandemic influenza when supplies will be scarce.

Key Findings: None to date.

Status: This five-year project is scheduled through September 2015. Laboratory research to assess correlation between influenza aerosol sampling and PPE contamination and to optimize protocols for extracting virus from PPE and shipping samples from the field site has begun. A pilot field test at a JHU healthcare facility is planned for February 2013.

Link: http://www.cdc.gov/niosh/nas/ppt/QUADCharts12/TRB_INH_939ZUNP_FY12_QC.html

Point of Contact: CDC-INFO

 
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  • Page last reviewed: February 18, 2011
  • Page last updated: January 7, 2013
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