Healthcare Respiratory Protection Resources

Updated May 8, 2020

Hazard Evaluation and Respirator Selection

Hazard Evaluation and Respirator Selection

NIOSH Documents

Better Respiratory Equipment Using Advanced Technologies for Healthcare Employees pdf icon[PDF – 517 KB]
The Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (Project BREATHE) Working Group (WG) is a U.S. Federal government interagency effort, initiated by the Depart-ment of Veterans Affairs, whose purpose is to develop a set of consensus recommendations that aim to improve respiratory protective equipment used by healthcare workers (HCWs). With representatives from nine (9) Federal departments and agencies, this multi-disciplin-ary team had a broad range of expertise, including pan-demic and emergency preparedness, infectious disease medicine and epidemiology, respirator and personal protective equipment policy and regulation, occupa-tional and environmental medicine, respirator and ma-terials science, infection control, respirator physiology and physics and bio-security. The WG was co-chaired by staff from the Veterans Administration (VA) and the Centers for Disease Control and Prevention (CDC). This report consists of 28 consensus recommendations for consideration by respirator manufacturers, research organizations, consensus standards development organi-zations, and respirator users and their employers.

Hospital Respiratory Protection Program Toolkit
This toolkit was developed to assist hospitals in developing and implementing effective respiratory protection programs, with an emphasis on preventing the transmission of aerosol transmissible diseases (ATDs) to healthcare personnel.

Healthcare personnel are paid and unpaid persons who provide patient care in a healthcare setting or support the delivery of healthcare by providing clerical, dietary, housekeeping, engineering, security, or maintenance services. Healthcare personnel may potentially be exposed to ATD pathogens. Aerosols are particles or droplets suspended in air. ATDs are diseases transmitted when infectious agents, which are suspended or present in particles or droplets, contact the mucous membranes or are inhaled.

Implementing Hospital Respiratory Protection Programs: Strategies from the Fieldexternal icon
Protecting workers from exposure to all types of respiratory hazards is an important issue for hospitals and other healthcare organizations. In order to address this often overlooked danger, The Joint Commission and Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), National Personal Protective Technology Laboratory (NPPTL) have collaborated to develop a new educational monograph designed to assist hospitals in implementing their respiratory protection programs (RPPs).

Respirator Awareness: Your Health May Depend on it
One of the occupational hazards in the healthcare setting is the airborne transmission of certain infectious diseases. The potential of exposure is not limited to physicians, nurses, and support personnel in direct patient care. It extends to those delivering food, cleaning patient rooms, and performing maintenance. Anyone working in areas with patients infected with airborne-transmissible diseases is potentially at risk.

Respirator Evaluation in Acute Care Hospitals Study (REACH) (2009 – 2010)
NIOSH identified and evaluated the usage of respiratory protection for influenza exposure among healthcare workers.

Guidance for the Selection and Use of Personal Protective Equipment (PPE) I Healthcare Settingspdf icon
Powerpoint presentation addressing methods to improve personnel safety in the healthcare environment through appropriate use of PPE.

Understanding Respiratory Protection Against SARS
SARS (severe acute respiratory syndrome) appears to spread primarily by close person-to-person contact with symptomatic individuals (e.g., persons with fever or respiratory symptoms). SARS can be spread by touching the skin of other people or objects contaminated with infectious droplets and then touching the eyes, nose, or mouth. Contamination occurs when someone with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread further through the air by very small particles. This method is called airborne transmission, but investigations to date suggest that this type of transmission is unusual. It also is possible that SARS may be spread by other ways that are currently not known.

NIOSH Respirator Decision Logic
NIOSH routinely makes recommendations regarding the use of respirators for workers exposed to environments that contain hazardous concentrations of airborne contaminants or oxygen-deficient atmospheres. This document provides industrial hygienists and other professionals knowledgeable in respirator selection with a procedure for selecting suitable classes of respirators for particular concentrations of specific contaminants.

Control of Smoke from Laser/Electric Surgical Procedures
NIOSH research has shown airborne contaminants generated by these surgical devices can be effectively controlled. Two methods of control are recommended to…

Waste Anesthetic Gases – Occupational Hazards in Hospitals
Waste anesthetic gases are small amounts of volatile anesthetic gases that leak from the patient’s anesthetic breathing circuit into the air of operating rooms during delivery of anesthesia. These gases may also be exhaled by patients recovering from anesthesia. Waste anesthetic gases include both nitrous oxide and halogenated anesthetics such as halothane, enflurane, isoflurane, desflurane, sevoflurane, and methoxyflurane (no longer used in the United States). The halogenated anesthetics are often administered in combination with nitrous oxide. Nitrous oxide and some of the halogenated anesthetics may pose a hazard to hospital workers.


Infographic - NIOSH Reach II Study: Understanding and Selecting Respiratory Protection Devices

NIOSH Reach II Study: Understanding and Selecting Respiratory Protection Devices (2011-2012)
Infographic addressing situations that require respiratory protection and whether an N95 FFR or a surgical mask should be utilized.
PDFpdf icon [445 KB], Imageimage icon [1,940 KB]

Infographic - Required Labeling of NIOSH-Approved N95 Filtering Facepiece Respirators

Required Labeling of NIOSH-Approved N95 Filtering Facepiece Respirators (2014)
Infographic depicting the required labeling for all NIOSH-approved N95 filtering facepiece respirators.
PDFpdf icon [488 KB], Imageimage icon [1,968 KB]

Infographic - Considerations for Respirator Selection in Healthcare

Considerations for Respirator Selection in Healthcare (2017)
PDFpdf icon [90 KB], Imageimage icon [517 KB]

Infographic - NIOSH Respirator Filter Classes

NIOSH Respirator Filter Classes (2018)
PDFpdf iconpdf icon, Imageimage iconimage icon

Infographic - Understanding the Difference

Understanding the Difference (2018)
PDFpdf iconpdf icon, Imageimage iconimage icon

Understanding the Difference (surgical masks, N95 FFRs, and Elastomerics) - Infographic

Understanding the Difference
(surgical masks, N95 FFRs, and Elastomerics)
PDFpdf iconpdf icon, Imageimage iconimage icon

Institute of Medicine (IOM) Reports

Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel Update 2010external icon
In light of the unanswered research questions following the 2009 H1N1 influenza pandemic, NPPTL asked the IOM to assess the progress of personal protective equipment (PPE) research and to identify future directions for PPE for healthcare personnel. While the IOM finds that there are gaps and deficiencies in the research about PPE use in health care, there is sufficient knowledge to recommend a four-pronged strategy for effective PPE use.

Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A: A Letter Reportexternal icon
During any flu season, health care workers are at the front lines of fighting the disease and protecting public health. In preparation for this year’s fall and winter flu season with novel H1N1 influenza A (nH1N1), the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration asked the Institute of Medicine to provide recommendations on necessary respiratory protection for healthcare workers in their workplace against nH1N1.

The Use and Effectiveness of Powered Air-Purifying Respirators in Healthcare: Workshop Summaryexternal icon
Protecting 18 million United States health care workers from infectious agents—known and unknown—involves a range of occupational safety and health measures that include identifying and using appropriate protective equipment (CDC, 2014a). The 2009 H1N1 influenza pandemic and the 2014 Ebola virus outbreak in West Africa have called attention to the importance of personal protective equipment (PPE) in different health care settings and have raised questions about how best to ensure appropriate and effective use of different kinds of PPE (such as respirators), not only to promote occupational safety but also to reduce disease transmission, in general.


Understanding the Use of Imported Non-NIOSH-Approved Respirators
When a respirator has been approved by NIOSH, the user can be confident that the device will provide the expected level of protection, as long as it fits properly and is worn correctly. But when serious outbreak conditions cause a shortage of the NIOSH-approved filtering facepiece respirators (FFRs), other reliable options must be found.

Respiratory Protection During Outbreaks: Respirators versus Surgical Masks
Consistent use of personal protective equipment (PPE) is an important part of the strategy to protect healthcare professionals from inhaling infectious particles, preventing the spread of respiratory infection between healthcare professionals and patients.

Understanding respiratory protection options in Healthcare: The Overlooked Elastomeric
In the healthcare industry, the importance of respiratory protection is often overlooked. Choosing the correct respirator for the exposure level and work task is a critical component of a respiratory protection program.

Catching the Flu: NIOSH Research on Airborne Influenza Transmission
As we enter another influenza season, one question continues to vex medical and public health professionals: How do you stop people from catching the flu?

N95 Respirators and Surgical Masks
With the advent of a novel H1N1 influenza outbreak in spring 2009 and the expectation of a second wave during the 2009–2010 flu season, there has been considerable interest in the use of surgical masks (facemasks) and respirators as infection control measures. Although their appearance is often similar, respirators are designed and engineered for distinctly different functions than surgical masks.

Do We Need to Challenge Respirator Filters With Biological Aerosols?
The purpose of this NIOSH Science Blog is to explain what is currently known about an important aspect of respirator filtration. For decades, respirator researchers have been asked whether filters need to be tested with aerosols similar to those encountered in the environment (Figure 1).

Respiratory Protection for Workers Handling Engineered Nanoparticles
When selected, maintained and used in the context of an Occupational Safety and Health Administration (OSHA)-compliant respiratory protection program, in which personal protective technology is part of the hierarchy of controls to protect the worker, respirator users can expect that their respirator is working and reducing the amount of hazards that they could potentially breathe. However, as new hazards emerge, the applicability of the science that NIOSH uses to base respirator test methods, performance requirements, and use recommendations needs to be continually reaffirmed, updated, and improved to assure the expected level of protection is provided.


A Particle is a Particle

Respirators: your TB Defense

Journal Articles

Clearing the air: surgical smoke and workplace safety practices
Harkavy-LM; Novak-DA, OR Nurse. 8(6):1-7, November 30, 2014

Understanding and controlling the hazards of surgical smoke
Novak-DA; Benson-SM, Prev Infect Ambul Care 2010 Dec; :1, 3-5

Selecting models for a respiratory protection program: what can we learn from the scientific literature?
Shaffer-RE; Janssen-LL, Am J Infect Control 2015 Feb; 43(2):127-132

Resistance to synthetic blood penetration of National Institute for Occupational Safety and Health-approved N95 filtering facepiece respirators and surgical N95 respirators
Rengasamy-S; Sbarra-D; Nwoko-J; Shaffer-R, Am J Infect Control 2015 Nov; 43(11):1190-1196

The use of respirators to reduce inhalation of airborne biological agents
Janssen-L; Ettinger-H; Graham-S; Shaffer-R; Zhuang-Z, J Occup Environ Hyg 2013 Aug: 10(8):D97-D103

Capture of 0.1-um aerosol particles containing viable H1N1 influenza virus by N95 filtering facepiece respirators
Harnish-DA; Heimbuch-BK; Balzli-C; Choe-M; Lumley-AE; Shaffer-RE; Wander-JD, J Occup Environ Hyg 2016 Mar; 13(3):D46-D49

Challenge of N95 filtering facepiece respirators with viable H1N1 influenza aerosols
Harnish-DA; Heimbuch-BK; Husband-M; Lumley-AE; Kinney-K; Shaffer-RE; Wander-JD, Infect Control Hosp Epidemiol 2013 May; 34(5):494-499

Physiological evaluation of air-fed ensembles
Turner-NL; Powell-JB; Sinkule-EJ; Novak-DA, Ann Occup Hyg 2014 Mar; 58(2):241-250

Are exhalation valves on N95 filtering facepiece respirators beneficial at low-moderate work rates: an overview
Roberge-RJ, J Occup Environ Hyg 2012 Nov; 9(11):617-623

Page last reviewed: May 8, 2020