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Healthcare Respiratory Protection Resources

Hazard Evaluation and Respirator Selection

Hazard Evaluation and Respirator Selection

NIOSH Documents

Elastomeric Half Mask Respirator Resources
This webpage was developed to provide information on NIOSH studies and resources related to elastomeric half mask respirators (EHMRs). EHMRs are a type of air-purifying respirator and are reusable devices with exchangeable filter elements (cartridges or filters) that may be selected to provide the needed level of filtration (e.g., N95).

Respirator Exhalation Valve Research
This webpage was developed to provide information on the research NIOSH is conducting on respirators with exhalation valves. The research aims to determine the potential for respirators with exhalation valves to contribute to source control (i.e., their ability to filter respiratory secretions to prevent disease transmission to others).

Better Respiratory Equipment Using Advanced Technologies for Healthcare Employees [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 Department 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-disciplinary team had a broad range of expertise, including pandemic and emergency preparedness, infectious disease medicine and epidemiology, respirator and personal protective equipment policy and regulation, occupational and environmental medicine, respirator and materials 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 organizations, 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 Field
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 Settings
Power Point presentation addressing methods to improve personnel safety in the healthcare environment through appropriate use of PPE.

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.
PDF [445 KB], Image [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.
PDF [488 KB], Image [1,968 KB]

Infographic - Considerations for Respirator Selection in Healthcare

Considerations for Respirator Selection in Healthcare (2017)
Infographic showcasing the different considerations when selecting a respirator for healthcare use.
PDF [90 KB], Image [517 KB]

Infographic - NIOSH Respirator Filter Classes

NIOSH Respirator Filter Classes (2018)
Infographic showing the classification of filtering media in respirators.
PDFpdf icon, Imageimage icon

Infographic - Understanding the Difference

Understanding the Difference (2018)
Infographic breaking down the differences between a surgical mask and a N95 respirator.
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Understanding the Difference (surgical masks, N95 FFRs, and Elastomerics) - Infographic

Understanding the Difference
(surgical masks, N95 FFRs, and Elastomerics)
Infographic breaking down the differences between a surgical mask, N95 respirator, and elastomeric respirator.
PDFpdf icon, Imageimage icon

What are Atmosphere-Supplying Respirators? Infographic

What Are Atmosphere-Supplying Respirators? (2019)
Infographic describing the different types of atmosphere-supplying respirators.
PDFpdf icon, Imageimage icon

What are Air-Purifying Respirators?

What Are Air-Purifying Respirators? (2017)
Infographic describing the different types of air-purifying respirators.
PDFpdf icon, Imageimage icon
Español – PDF, Image

Institute of Medicine (IOM) Reports

Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel Update 2010
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.

The Use and Effectiveness of Powered Air-Purifying Respirators in Healthcare: Workshop Summary
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.


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.

Heat Stress Imposed by PPE Worn in Hot and Humid Environments
Heat stress is a potential stress factor that healthcare workers (HCWs) who use personal protective equipment (PPE) and their employers should be aware of in order to recognize the signs and be prepared with the knowledge of how to alleviate the burden.

The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts
Particular features of PPE can impose a physiological (how the body normally functions) burden on HCWs which can be exacerbated by long work hours without adequate breaks for eating, hydration and self-care.


A Particle is a Particle

Respirators: your TB Defense

Journal Articles

Computational Fluid Dynamics Simulation of Outward Leakage of Exhale Particles from PAPR Wearers in Surgical Settings
Xu SS; Lei Z; Zhuang Z; Bergman M
Proceedings of the ASME 2019 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference, (IDETC/CIE 2019), August 18-21, 2019, Anaheim, California. Volume 1: 39th Computers and Information in Engineering Conference. New York: The American Society of Mechanical Engineers, paper no. DETC2019-98041, 2019 Nov; 1:DETC2019-97826, V001T02A048

A pilot study of minimum operational flow for loose-fitting powered air-purifying respirators used in healthcare cleaning services
Zhu J; He X; Bergman MS; Guffey S; Nimbarte AD; Zhuang Z
J Occup Environ Hyg 2019 Jul; 16(7):440-445

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel. A Randomized Clinical Trial
Radonovich LJ Jr.; Simberkoff MS; Bessesen MT; Brown AC; Cummings DAT; Gaydos CA; Los JG; Krosche AE; Gibert CL; Gorse GJ; Nyquist A-C; Reich NG; Rodriguez-Barradas MC; Savor Price C; Perl TM
JAMA J Am Med Assoc 2019 Sep; 322(9):824-833

Evaluation of rigidity of surgical N95 respirators using a manikin-system: A pilot study
Rengasamy S; Niezgoda G
J Int Soc Respir Prot 2019 Oct; 36(1):18-27

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