OSHA Issues Guidance for Stockpiling Masks and Respirators
By Eric Toner, M.D., May 30, 2008
The Occupational Safety and Health Administration (OSHA) recently proposed guidance for employers to use in determining the numbers of masks and respirators to stockpile for an influenza pandemic.1 OSHA’s guidance addresses the various levels of respiratory risk that employees may face and the type of protection needed at each level. The guidance also addresses methods for calculating the required numbers and costs to stockpile masks and respirators. While not obligatory, this guidance should prove useful to hospital pandemic planners in making informed decisions about stockpiling.
Respirators for High Exposure Risk Groups; Face Masks for Medium Exposure Risk Groups
OSHA’s proposed guidance describes the types of masks or respirators needed by various healthcare workers (HCW) based on their exposure risk. Most HCWs are at high or very high risk of exposure and should use a respirator instead of a mask for protection. Respirators should be rated N95 or higher and can be any one of several types, including a common disposable N95 filtering face piece, a surgical respirator, a reusable elastomeric (flexible rubber) respirator, or a powered air purifying respirator (PAPR). HCWs with limited exposure to patients may fall in the medium risk category; for this group, a surgical mask is appropriate protection. Also noted is the need to provide masks for essential visitors, such as parents of small children and patients with flu-like illnesses in the emergency department and waiting rooms. A comparison of the advantages, disadvantages, and relative costs of the various types of respirators and masks is included.
OSHA Provides Methods for Estimating Stockpile Numbers and Costs
The guidelines provide estimates of the number of respirators or masks needed per HCW, expressed as masks per shift. With these estimates, along with assumptions about the duration, attack rate, and severity of an epidemic, a planner can calculate the number and cost of masks and respirators needed to protect HCWs.
Interestingly, the analysis of the cost to protect one HCW at high risk of exposure reveals that it may be far less expensive in the long run to stockpile more expensive reusable elastomeric respirators than it would be to stockpile inexpensive disposable N95 filtering face pieces. And both of these options are less expensive than PAPRs. The calculation assumes two 12-week pandemic waves, during which time the HCW could be expected to use:
1 PAPR with spare hoods, batteries, and filters for $330 total;
480 N95 filtering face pieces @ $.50/each for $240 total; or
1 reusable elastomeric respirator every day with periodic filter changes for $40 total.
OSHA Guidelines and Hospital Data Will Support Informed Decisions about Stockpiling
Since re-supply during a pandemic may be difficult or impossible, stockpiling critical supplies such as masks and respirators is important. This guidance, used in conjunction with a hospital’s actual data on cost of respirators and masks and numbers of staff, along with credible assumptions about numbers of pandemic patients, will allow hospital pandemic planners to make informed decisions about stockpiling.
U.S. Department of Labor, OSHA. Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza. May 12, 2008. http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html. Accessed May 28, 2008.