Healthcare professional receiving her vaccination from a nurse.

Engineering, Administrative Controls, and Personal Protective Equipment for Healthcare Personnel

Options for Reducing Exposures when Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease


Controlling exposures to occupational hazards is a fundamental way to protect personnel. CDC has provided recommendations for initial infection control in healthcare settings for patients who may be infected with a novel influenza A virus associated with severe disease . This website expands on those elements to prevent transmission including engineering and administrative controls.

Traditionally, a hierarchy of controls has been used to achieve feasible and effective control and has some overlap. Some of the control measures may fall into multiple categories. It should also be emphasized that multiple control strategies can be implemented currently. This hierarchy can be represented as follows:

To prevent infectious disease transmission, elimination and substitution are not typically options for the healthcare setting. However, exposures to transmissible respiratory pathogens in health care facilities can often be reduced or possibly avoided through engineering and administrative controls and personal protective equipment (PPE).

N95 respirators (i.e., filtering facepiece respirators) are the PPE most often used to control exposures to airborne transmissible respiratory infections, though their effectiveness is highly dependent upon proper fit and use. Planners estimate that in a severe pandemic, more N95 respirators would be needed than industry can supply—shortages of N95 respirators were observed during the 2009 H1N1 pandemic influenza season. However, it is important to recognize that the optimal way to prevent transmission of airborne transmissible respiratory infections in healthcare facilities is to use a combination of interventions from across the hierarchy of controls, not just PPE alone. Applying a combination of controls can provide a degree of protection, even if one intervention fails or is not available.

This website provides interventions from across the hierarchy of controls that can be used in combination to reduce pathogen transmission even if one intervention, such as N95 respirators, becomes unavailable during a pandemic. These controls were originally recommended for controlling influenza exposures in the workplace; however, the principles may be applicable to other transmissible respiratory pathogens. The Occupational Safety and Health Administration also provides resources about preparing workplaces for an influenza pandemic on their website (need updated link, original does not work). This guidance may change based on the specific transmissible respiratory disease characteristics.

Engineering Control Solutions

Engineering controls reduce exposures for employees by removing the hazard from the process or placing a barrier between the hazard and the employee. Engineering controls can be very effective as part of a suite of strategies to protect employees without placing primary responsibility of implementation on the employee. NIOSH offers the following engineering control solutions that aim to reduce airborne respiratory infection transmission potential within healthcare settings.

Administrative Control Solutions

The term administrative controls refer to employer-developed work practices and policies that may reduce or prevent hazardous exposures. Their effectiveness depends on employer commitment and employee acceptance, patient compliance and consistent use of the strategies. Regular monitoring and reinforcement are necessary to ensure that policies and procedures are followed consistently. NIOSH offers the following administrative control solutions that aim to reduce respiratory infection transmission potential within occupational healthcare settings.

Personal Protective Equipment Solutions

While engineering and administrative controls should be considered first when selecting controls, the use of PPE should also be part of a suite of strategies used to protect personnel. Employing multiple strategies simultaneously including engineering and administrative controls and PPE offers the optimal environment to reduce transmission of respiratory diseases, such as novel influenza A viruses, in healthcare settings. More information about PPE options is available on the NIOSH Respirator Trusted-Source Information webpage.

Page last reviewed: March 7, 2017