ORC Guidance for Selection and Management of Respirators and Facemasks for Use against Exposure to 2009 Influenza A H1N1

A major concern for employers during times of communicable disease outbreak is how best to protect their people.  Loss of essential personnel to illness can have a devastating impact on business.  In most cases, it is not practical to prevent exposure to airborne viruses or bacteria by having employees work at home, nor can employers identify and isolate people who may be infected, but not yet manifesting symptoms, before they can infect others.  It therefore becomes necessary to provide employees with both the guidance and the means for maintaining health in the workplace.

Respirators and Surgical Facemasks

An initial thought that employers may have when faced with an outbreak of communicable disease is to provide employees with some form of respiratory protection. Employees may demand it, but employers must be aware of the pros and cons of selecting and managing such equipment, lest the health risk be exacerbated by inappropriate or incorrect use.

Two types of devices typically are mentioned as options to prevent the spread of infection during such episodes—surgical face masks and N95 disposable or filtering face piece respirators.  N95 respirators and surgical facemasks are uniquely different from other types of protective equipment such as hard hats and safety glasses.  Each has a distinctly different function.  A surgical face mask (or “face mask”) is designed to be worn by an infected person to prevent spread of infectious droplets from sneezing, coughing or talking. It may also be useful in providing some protection against splashes or large droplets generated by others.  Since it does not seal tightly around the face and is not designed to filter out airborne particles of the size of the influenza virus, a facemask will not protect the wearer from airborne influenza virus.

An N95 disposable or filtering face piece respirator is designed to protect the wearer from airborne particulate contaminants.  It is capable of forming a tight seal against the face and of filtering particles of the size of the influenza virus.  It has limitations, however, in that personal attributes--including facial hair, dentures, the size and/or shape of one’s face--can prevent a tight face seal. Without a tight seal, the N95 will not provide reliable protection against airborne virus particles.  In addition, it is necessary to evaluate each person’s ability to perform his or her job while wearing a respirator, because people with lung or respiratory impairment may have difficulty. It is important, therefore, to use careful judgment when deciding who should be provided with N95 respirators.

In order to be effective, employee respiratory protection should always (even in an emergency setting or in countries where OSHA regulations are not enforced) be administered according to the principles described in OSHA’s respiratory protection standard, 29 CFR 1910.134.  Adhering to these requirements provides a high level of confidence that the respirator will protect the wearer(s) if properly worn. Additionally, at a minimum, local respiratory protection regulations must be observed in countries that have their own.

OSHA has recently published a factsheet (attached below) entitled "Respiratory Infection Control: Respirators Versus Surgical Masks" which employers may find useful.

Official U.S. Government Guidance

In the US, both OSHA and the Centers for Disease Control and Prevention (CDC) have issued guidance for protecting employees during an influenza outbreak.   In 2007, OSHA published “Guidance on Preparing Workplaces for an Influenza Pandemic.”  ORC recommends that employers consult this document when preparing and implementing plans to protect employees against pandemic influenza.  Also posted on OSHA’s main web site is, “Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza.”  This document contains inaccuracies, and is not recommended. OSHA has indicated that they may replace it with a revised guidance document.

The CDC guidelines Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic are similar to OSHA’ s and provide detailed advice on health protection procedures.  ORC recommends also consulting the CDC guidelines when implementing pandemic influenza plans.

If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures. 

Consult the OSHA Occupational Risk Pyramid for Pandemic Influenza and the corresponding risk-based procedures for protecting employees found in the OSHA guidance document for further advice on determining the specific methods of protection required for different employee groups.

According to the CDC Interim Guidance, no single action will provide complete protection, but a combination of steps can help decrease the likelihood of transmission.  Both documents recommend the following as primary preventive measures:

• Frequent hand washing;
• Covering coughs;
• Having ill persons stay home, except to seek medical care, and minimize contact with others in the household;
• Voluntary home quarantine of members of households with confirmed or probable H1N1 influenza cases;
• Reduction of unnecessary social contacts:
• Avoidance whenever possible of crowded settings.

If you have further questions regarding respiratory protective measures or preparedness plans for H1N1 Influenza, please contact ORC Worldwide consultants Ann Brockhaus, Scott Madar, or Dee Woodhull.