At the request of the National Personal Protective Technology Laboratory (which is part of the National Institute of Occupational Safety and Health), an Institute of Medicine committee studied personal protective equipment that healthcare workers would need in the event of an influenza pandemic. They conclude that we’re not adequately prepared. But they have some ideas about how to remedy that.

There are 13 million healthcare workers in the U.S. who will need protection if a pandemic strikes. Personal protective equipment, or PPE, is designed to protect the wearer from exposure to hazardous agents; respirators, gloves, gowns, and eye protection are among the PPE used in healthcare settings. (Medical masks, the authors note, are only designed to protect the patients from exhaled secretions of healthcare workers, not to protect the healthcare workers.)

Since the IOM committee was focusing specifically on a possible influenza pandemic, its first recommendation is to figure out just how influenza is transmitted. (Did you think we knew the answer to this already? This Effect Measure post will set you straight.) The study authors note that “it is not possible at the present time to definitively inform healthcare workers about what PPE is critical and what level of protection the equipment will provide in a pandemic.” They recommend that the Department of Health and Human Services work with global partners through the World Health Organization to initiate and support a global influenza research network.

The authors note that healthcare workers often don’t wear PPE even when its use is warranted, so institutions need to foster a “culture of safety.” In addition to urging healthcare organizations to promote appropriate PPE use, the authors recommend that NIOSH and CDC support research related to PPE best practices and compliance.

The final recommendation is innovate and strengthen PPE design, testing, and certification. The committee suggests more rigorous pre-market testing to ensure that healthcare PPE products are actually usable and effective in healthcare settings. Here, again, the authors see a major role for NIOSH in defining requirements, establishing assessment measures, and promoting a systems approach for PPE design and development. They recommend that NIOSH, FDA, and other relevant agencies strengthen the pre-market testing and post-market evaluation of PPE for healthcare workers. The authors also note that Congress will have to provide NIOSH with more resources if it’s going to take on this kind of role. 

This IOM report could help resolve a major gap in preparedness, if the people in charge heed its call. Bill Borwegan, occupational safety and health director of the Service Employees International Union, comments:

The more I read it, the more it appears to be a revolutionary document that could lead to a dramatic paradigm shift in how we view, respond to and advance healthcare worker health and safety. I urge that we all work together to widely circulate this report’s contents and urge that the recommendations be adopted.  First and foremost this will mean working to get Congress to appropriate the necessary funds for NIOSH to conduct and/or supervise the research that the report states is sorely needed.  

The findings in report seem analogous to the turning point we faced decades earlier before there was an accepted recognition that firefighters should be afforded suitable respiratory protection.  It is past the time for the research to be conducted so that we have greater assurances that the nation’s 13 million healthcare workers are adequately protected.

As we’ve learned before, there are some politicians who don’t support protecting healthcare workers – but there are also plenty of people who will stand up to those politicians and insist that healthcare workers get the protection they need.