One of the most overlooked item in many business and personal preparedness gear is face masks and respirators.
Dusts, gases, fumes, mists and vapors are common hazards in workplace air. These can seriously affect the health of workers. Breathing in asbestos fibers can lead to asbestosis and lung cancer while crippling lung diseases can be caused by the inhalation of certain dusts.
Inhaling some chemicals, such as solvents, can damage many parts of the body including the brain. Welding fumes, smoke, mists from spray painting are also serious respiratory hazards and workers should be adequately protected from exposure to any of them.
In the event of a disaster most do not think about the debris that goes into our lungs. A great example of debris would be the terrorist attack in New York City on September 11th, 2001. The amount of debris that was blow out of the buildings when they collapsed was more than anyone could have imagined. Asbestos was blown down numerous city blocks and into the lungs of those trapped confused outside.
Facemasks are loose-fitting, disposable masks that cover the nose and mouth. These include products labeled as surgical, dental, medical procedure, isolation, and laser masks.
Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not designed to protect you against breathing in very small particles.
Facemasks should be used once and then thrown away in the trash.
A respirator (for example, an N95 or higher filtering facepiece respirator) is designed to protect you from breathing in very small particles, which might contain viruses. These types of respirators fit tightly to the face so that most air is inhaled through the filter material. To work most effectively, N95 respirators must be specially fitted for each person who wears one (this is called “fit-testing” and is usually done in a workplace where respirators are used). N95 respirators are most commonly used in construction and other jobs that involve dust and small particles. Some healthcare workers, such as nurses and doctors, use these types of respirators when taking care of patients with diseases that can be spread through the air.
If you have a heart or lung disease or other health condition, you may have trouble breathing through respirators and you should talk with your doctor before using a respirator.
Like surgical masks, N95 respirators should be worn only once and then thrown away in the trash.
One Size Doesn’t Fit All
While the N95 respirators haven’t been tested to see how effectively they block flu virus specifically, they are designed to block small particles and would be a logical choice for health workers. But N95s must be individually fitted to users’ faces so that air doesn’t seep into the sides, a problem for men with facial hair. Also, they come only in certain sizes, with none for children, and they’re uncomfortable to breathe in for long periods.
Regardless, if someone with flu sneezes on any mask wearer, the outside is contaminated, so users must remove them carefully to avoid infecting themselves, the IOM panel stressed.
More expensive reusable masks do exist, but there is no good way to decontaminate and reuse surgical masks and standard disposable N95s, the panel concluded.
It listed one exception: Someone could reuse his or her own N95 if the outside were protected from surface exposure, such as by placing a disposable surgical mask over it, stored it carefully to avoid creases or damage, and the user thoroughly washed hands before and after removal and rechecked the fit with each wearing.
What about using a handkerchief or some other improvised mask? They’re not likely as protective as even a surgical mask might be, but the panel hesitated to discourage use — assuming that some protection would be better than none. Generally, the tighter the fabric weave, the better.
Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness
This document provides interim guidance for the use of respirators and facemasks by individuals and families during an influenza pandemic. It was developed from existing U.S. Department of Health and Human Services guidance for the use of these devices in non-occupational community settings, posted on the internet at http://www.pandemicflu.gov/plan/community/maskguidancecommunity.html. While we do not have sufficient data to make science-based recommendations regarding every aspect of facemask and respirator use, individuals and families have requested additional information to assist in their pandemic influenza preparedness plans.
During an influenza pandemic, one may become ill following close contact with someone who is infected at home, in the community, at work, or at school. The best ways to reduce the chance of illness are to avoid crowded settings, reduce close contact with others (within about 6 feet), and practice good hygiene (handwashing and covering coughs and sneezes). Using protective measures in workplaces, reducing contacts among children by closing schools, and canceling public gatherings also are likely to further reduce the risk of infection if these measures are used in the event of a severe pandemic. Facemasks and respirators may further decrease, but will not eliminate the chance of becoming infected, so their use does not lessen the importance of reducing close contacts and improving hygiene: the best protection can be achieved by combining several measures, each of which will partially protect against pandemic influenza.
A facemask or respirator, if used correctly, may reduce the risk of acquiring or transmitting pandemic influenza illness in certain situations. Although the actual benefit of facemasks or respirators in preventing influenza transmission is unknown, use in certain situations may be warranted during a pandemic. If entry into a crowded setting is unavoidable (e.g., mass transit or going to a crowded store to purchase essentials such as medications), a facemask should be used, both to protect the wearer’s nose and mouth from other people’s coughs and sneezes, and to reduce the wearer’s likelihood of coughing or sneezing on others. A respirator should be used by individuals for whom close contact with an infectious person is unavoidable, such as when caring for a sick household member.
- The first and most important steps in reducing one’s risk of pandemic influenza are to limit close contact with others as much as possible and to practice good hygiene. These measures should be used at all times, regardless of whether a facemask or respirator is worn.
- When a person cannot avoid being in a crowd during an influenza pandemic – for example, because they must commute to work on public transit – but has no specific expectation of encountering a sick person, they should use a facemask.
- When it is necessary to have close contact with someone who is ill with pandemic influenza – for example, to give care to a family member – one should use an N95 respirator or equivalent certified by the National Institute of Occupational Health and Safety (NIOSH) and consider specifically using a respirator model that also is cleared by the U.S. Food and Drug Administration (FDA) for use by the general public in public health medical emergencies.
- Ill persons should use a facemask when they must be in contact with others.
A facemask (for example, a surgical mask) is a disposable mask that covers the nose and mouth. When used properly, facemasks may help protect against influenza by blocking droplets – created when someone coughs or sneezes nearby – from reaching the wearer’s nose or mouth. If someone who is infected with influenza wears a facemask, it will trap their own secretions and may help protect others who are nearby. A facemask also may help keep an uninfected wearer from touching their nose or mouth and potentially infecting themselves with influenza virus that is on their hands. Facemasks are inexpensive and are relatively comfortable to wear. Some small facemasks may fit larger children but children may have trouble wearing them correctly and consistently.
The FDA has cleared many facemasks. These facemasks have been tested to show that they can trap germs and resist fluids, and will not cause skin reactions or breathing difficulties. FDA-cleared facemasks are labeled to be used by healthcare professionals and generally marketed as medical products sold “over the counter” by medical supply companies. They may be labeled as surgical masks, procedure masks, isolation masks, dental masks, or laser masks. FDA has not cleared any facemasks specifically for use by children. Disposable masks that are not labeled for medical uses are not subject to FDA oversight and their quality is not known. Even if they look similar to facemasks, disposable masks not labeled for medical use, such as those commonly sold at hardware stores, may not provide the same protection against infection. Questions about a brand or type of facemask may be answered by a pharmacist or healthcare provider. General information on buying or wearing facemasks may be found on the FDA website, http://www.fda.gov/cdrh/ppe/masksrespirators.html. Instructions on how to correctly put on and take off a facemask are included with the packaging of some products. Correctly removing a facemask so that one is not exposed to contaminated mask surfaces is very important; good handwashing or use of a waterless hand-hygiene product before putting on and after taking off a facemask is critical.
An N95 filtering facepiece respirator is a disposable respirator that covers the nose and mouth. Like a facemask, a respirator will trap infected droplets. In addition, if worn correctly, it will protect against breathing in small particles that may contain viruses. Respirators, which generally are worn in healthcare and other occupational settings, are tested and certified by NIOSH. NIOSH-certified disposable N95 respirators are marked with the manufacturer’s name, the part number (P/N), the level of protection provided by the filter (e.g. an N95 respirator is certified to filter out 95 percent of the most penetrating particulates), and “NIOSH.” Non-certified respirators are available but their effectiveness has not been tested by NIOSH. For questions about a brand or type of respirator, consult the NIOSH website, http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/. Instructions for correctly putting on and taking off a respirator are included in the package. As with facemasks, correctly removing and disposing of the respirator to avoid becoming infected from secretions that may be on the device is important; it is critical that hands be washed or decontaminated with a waterless hand-hygiene product before putting on and after taking off a respirator.
A respirator works by fitting snugly against the face, forcing inhaled air to come through the filtering material. In workplaces where most N95 respirators are used, they are “fit tested” to assure that air does not leak around the sides of the respirator. Although fit testing programs generally are not available for the public, selecting an appropriate respirator, carefully following instructions for its use, and making sure that it fits tightly against the face are critical to ensuring the respirator provides protection. Facial hair or other items that interfere with a close fit will diminish effectiveness. FDA recently cleared the first respirators specifically intended for use by the general public during a public health medical emergency such as a pandemic. These respirators, which also are NIOSH-certified, have directions that are written for untrained users and were tested to show that adult users with a variety of facial sizes could obtain a protective fit using those instructions. Their labeling instructions address the other precautions also needed for the safe use of respirators during an influenza pandemic such as handwashing, proper storage before use, and proper disposal after use. Where these are available, they may be the best option for users without access to fit testing. No respirator, however, will fit all users and one may want to purchase several sizes or models to see which fits best (i.e., fits snugly against the contours of the face) before purchasing a larger quantity. There are no respirators designed for use by children. Because the material used to make respirators is denser than that used in facemasks, it may be more difficult to breathe through a respirator. Persons who have heart or lung disease or other illnesses that affect their breathing should consult a healthcare provider before using a respirator.
The effectiveness of both facemasks and respirators is reduced after they are worn for a long time and become saturated with moisture, or if they are torn or disfigured. At such times, they should be replaced. They can also become less comfortable to wear and may be more difficult to breathe through after extended use. Because the best ways to prevent influenza infection are to avoid crowds and reduce close contacts with others, there should not be a need to wear facemasks and respirators for long periods of time. In addition the facemasks and respirators should be removed when the wearer is no longer in a setting where close contact will occur. Never wash or disinfect disposable facemasks or respirators and never share used facemasks or respirators with others.
Settings where respirators and facemasks should be used will depend on the potential for exposure to infectious persons:
- A facemask is recommended when exposure in a crowded setting occurs with persons not known to be ill. An example would be exposure on a crowded bus or subway while commuting to work during a pandemic. Because ill persons are advised to stay home during a pandemic, contacts in most public settings will be with persons who are not ill. However, it is prudent to wear a facemask because one may encounter people who are infectious but not yet ill.
- A facemask also is recommended for use by ill persons when they must be in close contact with others. The facemask will trap the wearer’s secretions and reduce the risk to other persons. Close contact between ill persons and others should be limited as much as possible. However, such contact will occur when the ill person is being cared for at home or if they need to leave home to access medical care or manage other necessities. Ill persons do not need to wear a facemask when they are not in close contact with others
- A respirator is recommended for use in settings that involve close contact (less than about 6 feet) with someone who has known or suspected influenza illness. In non-occupational settings, the most common use for a respirator would be in a household where someone has influenza. One person should be responsible for taking care of the ill individual and that person should wear a respirator during those contacts. The Centers for Disease Control and Prevention (CDC) will be issuing guidance on home care of an ill person, which will be posted on the internet at www.pandemicflu.gov.
Families can use this guidance as the basis for making decisions about purchasing respirators and facemasks as part of household pandemic preparedness. Although not all households will have someone who becomes ill with influenza during a pandemic, because one cannot predict in which households an infection will occur, it would be reasonable for each household to stockpile some respirators that can be used, if needed, when caring for an ill family member. With proper precautions, a single caregiver can use the same respirator several times over a day for brief care visits with the same ill person in the household, so a stockpile of 20 respirators per household would be reasonable. Decisions on stockpiling facemasks and the number to obtain would depend on a family’s situation and their expectation of the need for close contact in crowded settings during a pandemic. Pandemic outbreaks in communities may last 6 to 12 weeks. Persons who cannot avoid commuting on public transit may choose to purchase 100 facemasks for use when going to and from work. An additional supply of facemasks also could be purchased for other times when exposure in a crowded setting is unavoidable or for use by an ill person in the home when they come in close contact with others. The cost of a box of 20 N95 respirators is about $15 – $30 and the cost of a box of 50 facemasks is about $10 – $20. Therefore, the total cost to a family to purchase the recommended number of respirators and facemasks would be about $35 – $70.
Because the supply of respirators and facemasks is limited, stockpiling only the amounts that may be useful during a pandemic and using them only when necessary will help assure that supplies are sufficient for all settings where they are needed: on a daily basis in healthcare and other workplace settings, and for pandemic preparedness among healthcare workers, emergency responders, and others who provide essential services in communities.
Stockpiling respirators and facemasks can contribute to pandemic preparedness in households but is not the only action that can be taken to prepare. Education on other measures to reduce the risk of being exposed and becoming ill, practicing good habits in handwashing and covering coughs and sneezes, as well as purchasing stockpiles of food and water all are recommended. Several scientific studies currently are being done to investigate the level of protection against influenza that may be provided by respirators and facemasks and the ability of persons to correctly and consistently use these devices. This interim guidance may be modified based on the results from these studies. Additional information on protecting oneself and one’s family in a pandemic is available at http://www.pandemicflu.gov/plan/individual/index.html.
 It is important to note that other NIOSH-certified N-, R-, or P- filtering facepiece respirators (e.g., N99, R95, and P100) provide an equal or greater level of exposure reduction to airborne particulates as an N95 and can be used if N95s are not available.
 If a respirator is used several times by a single caregiver for brief care visits with the same ill person, the outside of the respirator may become contaminated with secretions from the ill person; therefore care should be taken to keep the respirator away from other household members between uses and to wash hands well after putting the respirator on.
In previous pandemics, community outbreaks generally have lasted 6 to 8 weeks. Effective public health measures to reduce the spread of infection in communities (“community mitigation”) may reduce the overall severity of the pandemic outbreak but could lengthen its duration, potentially to 12 weeks.
 Facemasks and respirators should be stored in a dry, cool location, and protected from moisture, insects, dirt and extremes of temperature.
Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza
In the event of an influenza pandemic, employers will play a key role in protecting employees’ health and safety as well as in limiting the impact on the economy and society. Employers will likely experience employee absences, changes in patterns of commerce and interrupted supply and delivery schedules. To further preparedness efforts, the Department of Labor (DOL) proposes to publish this information on stockpiling respirators and facemasks in occupational settings as an appendix to the DOL and the Department of Health and Human Services (HHS) jointly issued Guidance on Preparing Workplaces for an Influenza Pandemic (February 2007). This proposed guidance is designed to encourage employers in the private and public sectors to purchase and stockpile facemasks and respirators in advance of an influenza pandemic, because manufacturing capacity at the time of an outbreak would not meet the expected demand for respiratory protection devices during the pandemic. Through advanced planning and stockpiling, employers will be able to better protect their employees as well as lessen the impact of a pandemic on their business, society, and the economy.
As is explained in more detail in this guidance, employers should consider stockpiling facemasks and respirators. More specifically, it is recommended that employees at very high risk and high risk of exposure to pandemic influenza use respirators, while employees at medium risk of exposure use facemasks. Neither facemasks nor respirators are recommended for employees at lower risk of exposure to pandemic influenza.
First FDA-Cleared Respirators For General Public Use In Public Health Medical Emergencies Now Available From 3M
Consumers concerned about an influenza outbreak can breathe a little easier: 3M has just released two new NIOSH N95 respirators for use by the general public in public health medical emergencies.
These two respirators – 3M™ Particulate Respirator 8612F and 3M™ Particulate Respirator 8670F – are unique because they are the first to receive clearance by the U.S. Food & Drug Administration (FDA) to reduce exposure to airborne germs during a public health medical emergency such as an influenza pandemic. The FDA outlined a special clearance process for N95 respirators used by the general public in public health medical emergencies in order to provide reasonable assurance of their safety and effectiveness.
Although use of respirators is only one of several precautions that can be taken in response to a public health medical emergency, “The release of these FDA-N95 respirators is a significant step in providing the public with guidance and products needed to help reduce exposure to airborne germs,” said Julie Bushman, division vice-president, 3M Occupational Health and Environmental Safety Division.
According to Bushman, 3M is taking steps to ensure the respirators are readily available to the public. “The need has grown as more people realize the importance of planning ahead for a public health medical emergency,” Bushman said.
New Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza
OSHA is calling for comments on the Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza document. OSHA will accept comments until July 8, 2008.
“This proposed guidance supplements the existing document Guidance on Preparing Workplaces for an Influenza Pandemic released last year,” said Assistant Secretary of Labor for OSHA Edwin G. Foulke, Jr. “We want to assist employers in equipping their workplaces with protective devices so that their employees remain safe and healthy in the event of an influenza pandemic.”
The proposed guidance offers private sector and government employers with recommendations and a method for calculating workplace stockpiling needs for respirators and facemasks. This allows employers to better protect their employees and reduce the impact of a pandemic.