IOM Issues Report on PPE and Pandemic Flu

October 9, 2007 -- The Institute of Medicine has released its report on Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. The IAFF participated in this process, officially addressing the panel and demanding evidence-based performance requirements for PPE for fire fighters and all health care workers.

Click here to read the full report, request a free PDF copy or order the manual.

Read more on Pandemic Flu Resources for First Responders.

For example, while N95 respirators are recommended by OSHA and CDC as the minimum level of respiratory protection when caring for patients infected with pandemic influenza, there is no scientific evidence to support that this respirator actually provides an adequate level of protection.

Developing and adopting the evidence-based performance requirement recommended by the IOM will ensure there is adequate protection from a respirator. The IAFF recommends, with scientific justification, a minimum of a P100 respirator if a filtering facepiece respirator is provided.

The IOM report provided recommendations on three primary areas to ensure health care workers are effectively protected during an influenza pandemic:

• Understanding influenza transmission
• Expanding the commitment to worker safety and appropriate use of PPE
• Encouraging innovation and strengthening of PPE design, testing and certification.


Understanding influenza transmission

The report also calls for a comprehensive global influenza research effort to fully understand the transmission of influenza and development of effective prevention and control strategies.

This IOM recommendation is important because:

• Little is known about the mechanisms and contribution of each of the possible routes of influenza virus transmission (airborne, droplet and contact) among humans. This knowledge is critical if effective preventive measures are to be implemented in emergency health care settings that will truly protect workers from becoming infected.
• While acknowledging the debate between airborne versus droplet transmission routes and lack of information about the contributions of each, the report concludes that given our current level of understanding, “all routes must be considered probable and consequential” if workers are to be adequately protected.
• This view that all routes must be considered probable substantiates the labor movement’s view that in the absence of full information on routes of transmission, a “precautionary approach” must be used at this point in time to ensure that fire fighters, emergency medical personnel and all health care workers are protected from pandemic influenza, including the use of respirators to protect against airborne transmission.

Worker safety and appropriate use of PPE

The institutional commitment to a culture of safety that establishes systems, policies and practices to ensure safety is the highest priority. It requires leadership commitment, education and training, adequate access to safety equipment and effectively increasing PPE use compliance. The report also emphasizes the need to identify and disseminate best practices in infection control.

These IOM report makes several important points:

• It stresses the importance of institutional commitment and responsibility for taking an “active role in facilitating, promoting and requiring safety actions.” In the absence of employers assuming responsibility to provide a safe workplace, fire fighters, emergency medical personnel and all health care workers will not be effectively protected.
• Wearing PPE is difficult because it’s uncomfortable and inhibits the ability to carry out work tasks easily, making worker use compliance a difficult issue. Rather than set the blame on individual workers for problems with the use of PPE, the focus must be on institutional issues that prevent or encourage noncompliance.
• By focusing on the necessity to identify and disseminate best practices in infection control, all employers need to have these infection control measures implemented in their workplaces. In labor’s view, this is best accomplished by having a mandatory OSHA pandemic influenza standard in place so all employers are required to put best practices in place.

Innovation in PPE design, testing and certification

The report calls for the development of evidence-based performance requirements for PPE, including issues addressing functionality, usability, comfort and wearability, durability, maintenance and reuse, aesthetics and cost.

These recommendations are important because:

• They require that the PPE used by health care workers protects them from the influenza virus. Adopting the evidence-based performance requirement will ensure adequate protection from a respirator.
• Workers don’t like to wear PPE and compliance with its use can be a problem because of discomfort and irritation. However, improvements in the comfort and wearability of PPE can decrease discomfort and assist with institutional efforts to improve use compliance.

Especially important to the IAFF is that the IOM calls for NIOSH to be the lead agency in this PPE research effort.

Click here to read the full report, request a free PDF copy or order the manual.

Read more on Pandemic Flu Resources for First Responders.