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IOM Releases Pandemic PPE Report

By Lewis J. Radonovich, M.D.,* October 4, 2007

On September 18, 2007, the Institute of Medicine (IOM) of the National Academies announced the publication of a report entitled, “Preparing for an Influenza Pandemic: Personal Protective Equipment (PPE) for Healthcare Workers.”1 A draft version has been circulated in a limited fashion and the final version is due for publication in January 2008.  A Report Brief is currently available as well.

This report was developed by an IOM standing committee on occupational PPE strategic guidance that was formed in response to a request from the National Personal Protective Technology Laboratory (NPPTL) at the National Institute for Occupational Safety and Health (NIOSH). IOM initiated a 12-month study that engaged an ad hoc group of experts in infectious diseases, infection control, public health, occupational safety and other pertinent fields. The committee was asked to examine research directions, the establishment and certification of standards, and risk assessment issues specific to healthcare worker PPE during influenza pandemic.

The IOM determined that there is an “urgent need” for an intensive study and policy development in three key areas:

  • Understanding influenza transmission

  • Commitment to worker safety and appropriate use of PPE

  • Innovation and strengthening of PPE design and certification.

Recent reviews2,3 about influenza transmission highlight the continuing scientific debate about this important subject. Despite extensive clinical experience and recent advances in bioscience, a conspicuous lack of knowledge exists about human-to-human transmission of influenza. Debate continues in scientific circles about the role of airborne, droplet, and contact transmission. Until this crucial subject is better understood, the value of each PPE measure that is implemented for healthcare workers will be uncertain.

The report notes that while PPE offers protection from occupational hazards, there are also drawbacks. For example: PPE hampers verbal communication, is uncomfortable, increases the work of breathing, and diminishes touch sensation. The IOM stresses that the shortcomings in PPE tolerability provide strong motivation for broad-based improvements in healthcare worker safety practices. However, in order to achieve a “culture of safety”, certain key actions are required, such as commitment from numerous levels of leadership, expanding and enforcing regulatory policies and shining a light on best practices. The IOM further states that the regulatory, certification, and evaluation requirements for PPE need to be revisited to ensure PPE are safe and effective. These processes have “evolved in a fragmented manner” and there is a need for “harmonization of requirements” for the entire lifecycle of PPE—from design to use in the workplace—using an evidence-based approach.

References

  1. Institute of Medicine. Preparing for an Influenza Pandemic: Personal Protective Equipment (PPE) for Healthcare Workers. Washington, DC: National Academies;  September 18, 2007. http://www.iom.edu/CMS/3740/29908/46095.aspx

  2. Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis. 2006 Nov:12(11):1657-62.  http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm

  3. Brankson G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7(4):257-65.

*The author is the Director of Biosecurity Programs at the North Florida/South Georgia Veterans Health System and an Adjunct Assistant Professor of Medicine at the University of Florida. The views expressed in this summary do not necessarily reflect those of the Department of Veterans Affairs, the North Florida/South Georgia Veterans Health System, other government agencies, or the University of Florida.