The Personal Protective Technology Program at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health (2008)

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4 Emerging Issues and Research Areas in Personal Protective Technology G iven the relevance and substantive impact of the National Institute for Occupational Safety and Health (NIOSH) Personal Protective Technol- ogy Program, (PPT Program) the committee provides this chapter as a forward look toward ensuring that the program is on the forefront of personal protective technologies. A full evaluation of emerging areas for PPT research and standards setting would require a comprehensive review of the field. This type of in-depth effort was not possible within the time allotted to the committee and the scope of its evaluation. In this chapter, in keeping with the guidance from the Framework Document, the committee provides suggestions on future directions in materials technology, human factors, ensemble integration, safety culture, and training, as well as ideas relevant to emerging areas in several other technical areas that reflect the expertise of individual committee members. The committee has not conducted a formal as- sessment of needs in the field of PPT research. PPT PROGRAM’S PROCESS FOR IDENTIFYING EMERGING ISSUES An essential characteristic of a high-performing program is its ability to an- ticipate, identify, and respond to emerging needs or opportunities, including those   As defined in Chapter 1, this report uses the term PPT Program to refer to the efforts from 2001 to the present that have been conducted by NIOSH relevant to the 12 PPT-relevant objectives that focus primarily on protection against respiratory and dermal hazards (Box 1-1). 101 

102 The Personal Protective Technology Program at N I OSH caused by external factors outside the control of the program. The PPT Program has demonstrated in the case of standards setting for CBRN respirators that given the resources and the mandate, it can move rapidly and effectively to address highly complex needs. In the evidence package provided to the committee and in subsequent discus- sions with NIOSH staff, the committee learned about the process by which the PPT Program’s research priorities are determined and decisions are made about participation in standards-setting efforts. For the certification process, NIOSH is bound by federal mandate to perform respirator certification as specifically laid out in the Code of Federal Regulations. NIOSH, through the PPT Program, can and does take the initiative to update the certification requirements to adapt to new technologies; however, this continues to be a lengthy endeavor and increased efforts are needed to expedite revisions to the regulations (see Chapter 2). Further, increased website information on the progress of each modification in the federal rule-making process would help open the process and make it more transparent. The PPT Program sets its research and other institutional priorities through an ongoing strategic planning process that culminates in an annual planning summit attended by the governance team comprised of key PPT Program managers. The governance team also meets periodically throughout the year to provide input into major decisions about emerging issues. The goals of the summit meeting are to conduct program assessments, identify priorities, and formulate the PPT Program budget for the coming year. This process began in 2006 as a National Personal Pro- tective Technology Laboratory (NPPTL) planning summit and expanded in 2008 to include input from the broader PPT Program. The committee urges continued efforts in future planning to systematically consider the range of research gaps relevant to the many types of protective equipment and technologies. As part of its strategic planning process, the PPT Program places an emphasis on obtaining input via stakeholder meetings held throughout the year with manu- facturers, workers, researchers, regulatory personnel, and others (see Box 2-1). Most recently, the PPT Program held a public stakeholder meeting on March 6, 2008. The PPT Program has been the sole or joint sponsor of a number of PPT-related conferences, such as the 2005 conference Advanced Personal Protective Equipment: Challenges in Protecting First Responders. These conferences highlight new research and products and are an important input into development efforts. Results of intra- mural and extramural research also provide input to the process as do feedback and interactions with the many collaborating partner organizations and agencies. On its website, NIOSH identifies the following emerging issues as top priori- ties for the PPT Program’s efforts to provide effective NIOSH-certified respiratory protection equipment for all workers: CBRN protections, pandemic influenza preparedness, mine-related research, and nanotechnology (NIOSH, 2007). 

Emerging Issues and Research Areas 103 In 2005, the PPT Program contracted with the Institute of Medicine (IOM) to establish a standing committee (the Committee on Personal Protective Equipment for Workplace Safety and Health) to provide ongoing discussions regarding stra- tegic issues relevant to PPT. Additionally, the PPT Program has sponsored several IOM and National Research Council (NRC) studies that have examined specific issues (anthropometric research, planning for pandemic influenza, and surveil- lance) identified by the standing committee and by NIOSH staff (IOM, 2007, 2008; NRC, 2007). Recommendations from the resulting reports have been used by the PPT Program as a basis for research planning. External factors can also drive the identification of new research issues or areas of focus (see Chapter 3). The 2001 terrorist attacks and the resulting national efforts to improve emergency response capabilities resulted in a number of PPT-related projects and efforts focused on improving the PPT for emergency responders. The threat of pandemic influenza and the 2003 outbreaks of severe acute respiratory syndrome (SARS) have also heightened interest in PPT for healthcare workers and for the general public. COMMITTEE’S ASSESSMENT OF THE PPT PROGRAM’S PROCESS The committee recognizes the many inputs to the PPT Program’s process for establishing research priorities. The PPT Program has had a number of public meetings and is now engaged in focusing these meetings on the broader range of protective technologies. The PPT Program has been very successful in engaging specific and familiar stakeholder groups, including respirator manufacturers and the emergency response community, and recognizes the need to expand into other work sectors. Further, the PPT Program has demonstrated its engagement in PPT policy development through participation in consensus standards development committees and through its interactions with other federal agencies. In developing its research priorities and other critical aspects of its program, the PPT Program needs to more closely follow a life-cycle approach to PPT test- ing with particular attention to increasing pre- and post-marketing field studies. This life-cycle approach should be implemented for all types of personal protective technologies. With regard to respirators, the development of standards establishes the basis for the certification program, which in turn would be supported by a series of pre-market and feasibility studies. Once fielded, the respirator equipment that has been certified is subject to product audits and manufacturing site audits. Additional field studies and more data from surveillance studies (discussed below) would be fundamental to implementing a truly iterative and cyclical process that yields ever-improved PPT. 

104 The Personal Protective Technology Program at N I OSH The PPT Program’s process for identifying and addressing emerging areas seems quite open and transparent, and the committee urges the PPT Program to continue in this manner as it reaches out to other workplace sectors. The PPT Program would also benefit from further expertise in behavioral sciences and in- terdisciplinary specialties, aimed principally at human factors. Given the ongoing challenges of workers’ noncompliance with PPT use, it is paramount that NIOSH recognize psychosocial, usability, comfort, and behavioral issues that profoundly modify the relationship between PPT design and user compliance. As discussed later in the chapter, the committee believes that one of the critical issues for PPT is the integration of protective products into usable ensembles that are coupled and interface with each other without introducing new hazards or reducing the effectiveness of any single product within an ensemble. In the committee’s assessment, efforts are needed to more fully integrate the PPT Program into the matrix of the NIOSH organization. Only recently have efforts been made to integrate a PPT emphasis into some of the cross-cutting components of NIOSH such as the Health Hazard Evaluation (HHE) program and surveillance efforts. The PPT surveillance action plan (NIOSH, 2008e), for example, is a start in the right direction in that it assesses the capacity of ongoing and proposed surveil- lance activities across NIOSH to inform PPT research needs. EMERGING ISSUES IDENTIFIED BY THE COMMITTEE The committee identified several overarching emerging issues that affect all types of PPT. In addition, several specific areas for future research are suggested. New Materials Technologies Because the effectiveness of most PPT is dependent on acting as a barrier to haz- ardous agents, the usefulness of PPT can be jeopardized by ill-fitting, burdensome, or hard-to-wear products. This is especially a concern for respirators where even the most effective filter is only as good as the users’ desire to don the respirator, the lack of leakage of the respirator, and the surety of fit. New materials technologies offer many opportunities for improving fit and comfort. A recent IOM report on personal protective equipment for healthcare workers (IOM, 2008) discussed some of the technologies on the near horizon including shape memory polymers. Further, rapidly evolving knowledge in materials sciences and engineering may yield as-yet-undefined technologies that could change the fundamental nature of PPT and perhaps eventu- ally develop protective mechanisms that negate the need for PPT. The PPT Program plans to hold a workshop in late 2008 to examine the tech- nologies available to move toward a “fits-all” or “universal-fit” respirator that could 

Emerging Issues and Research Areas 105 easily and effectively conform to all face types and would not require fit testing. The committee believes that workshops such as this one are an excellent example of the PPT Program’s leadership in this area and encourages NIOSH to continue to explore cutting-edge technologies by bringing together experts of diverse design, engineering, technological, and behavioral backgrounds. Usability and Human Factors One of the major weaknesses of PPT is its dependence on the individual user. PPT can protect only when worn as designed—a simple fact, but one that has many ramifications: workers need to see the value of wearing PPT; they must use the equipment correctly in order to be protected against the hazard; they have to be able to accomplish their work tasks while wearing the equipment; and they need to be comfortable while wearing PPT so that they will continue to wear it. PPT development and application pose two significant challenges. The first is to ensure that the equipment is efficacious, providing protection from the hazard for which it is designed. The second is effectiveness so that when used in the workplace, PPT provides the intended protection, fits a variety of human shapes in a highly di- verse workforce, and is user-friendly. A growing realization is that comfort is a safety issue. Other key aspects of usability are durability and serviceability since there must be a high confidence that PPT will continue to provide adequate protection for the duration of the planned tasks under foreseeable conditions. Designing for usability spans several disciplines including engineering, behavioral sciences, training systems design, and human resources management, as well as interdisciplinary specialties such as human factors. The extent to which PPT can be designed to be efficacious, usable, practical, and effective in the context of its use will rest on the extent to which the PPT Program integrates different disciplines into the design, development, and evaluation of PPT. For example, the burden on miners of using a self-contained self- rescuer (SCSR) in an emergency escape needs to be evaluated and considered on an integrated basis. This evaluation should address the use of an SCSR in the context of high temperature, high humidity, and high metabolic rate. Systematic laboratory- and field-based studies need to be conducted that support the development of performance goals and technologies for heat stress reduction and other physiologic burdens resulting from wearing PPT. The impact of protective equipment on the susceptibility of users to heat stroke is an important area of inquiry. The PPT Program has recently added a physiology laboratory and now has the capacity to expand its work in this discipline. The committee urges increased efforts in this important area. The value of addressing design and usability is only beginning to be fully recognized in PPT and related areas, although it has been an important feature of 

106 The Personal Protective Technology Program at N I OSH product design and evaluation in many other industries. Considerable progress has been made in adapting laboratory procedures to improve fit, but much more work remains to be done to address gender differences and the wide variation of sizes, shapes, and heights across an increasingly diverse worker population. Poor fit of protective equipment and clothing is a serious issue for men with small- or large- size frames and for many women workers. Indeed, much of the technology of PPT has evolved without consideration of the variations in frames and features; work needs to be done to enhance gender equity in PPT design. The significant growth of the number of females in nontraditional workplaces, such as the construction trades, lends some urgency to the need for attention to issues of fit and usability. Some initial work designed to improve awareness and research on issues con- cerning women and the use of personal protective equipment has been the result of a NIOSH-Department of Labor (DoL) working group on women and PPT. The working group has commissioned the design of a survey to obtain data on the PPT needs of women; the PPT equipment they wear; and their views on the comfort, fit, and usability of that equipment (American Society of Safety Engineers, 2007). Initial cognitive assessments have been undertaken with a pilot cohort of 21 women and men of short stature in construction, mining, law enforcement, and health care (MSHA, 2007). The committee encourages the NIOSH PPT Program to become further involved in these efforts and to expand work to improve PPT for individuals across a broad spectrum of body frames and features. Although much work has been done on developing consensus standards for the performance effectiveness of PPT (particularly as related to respirators), few standards exist regarding wearability and physiologic burden. The PPT Program, along with manufacturers, employers, workers, and standards development orga- nizations, needs to work toward setting such standards. PPT Ensembles and Systems Integration Many hazardous workplace situations require workers to use multiple types of PPT. Firefighters face the respiratory hazards of smoke inhalation while at the same time confronting the challenges of extreme heat and flames that pose dangers to all parts of the body. Healthcare workers concerned with exposure to bloodborne pathogens need protection for all potential exposure points including the eyes, mouth, nose, and broken skin. Construction workers may need protection from the noise of their equipment while also requiring respiratory protection from dust and the safety of fall protection technologies for jobs at dangerous heights. Seamless integration of various types of PPT is thus critically important. PPT ensembles bring to mind coats and gloves and helmets but also should include a range of products that allow multiple protective technologies to be added without 

Emerging Issues and Research Areas 107 gaps or loss of protection (for example, respirators need to integrate with both eye protection and hearing protection). Similarly, workers must be shielded from hazardous atmospheres without impeding seeing, hearing, and communication. Developing PPT ensembles will need to involve the standardization of fittings and seals so that PPT components and technologies can be truly integrated and interoperable. PPT Program staff members have worked with the International As- sociation of Fire Fighters and others to develop and test ensembles for firefighters that integrate protective and functional gloves into firefighter coats. A focus is needed on innovations that can provide workers and employers with protective ensembles and interfaces appropriate for the varying PPT needs across different occupations and industries. Input from the National Occupational Research Agenda (NORA) Sector Councils and extramural partners can be useful in focusing on the relevant PPT issues. Advancements in PPT may also have to be considered in the design of environ- mental controls. For example, a new comprehensive program should be considered that takes a fresh look at all of the hazards that miners face in carrying out their jobs in both underground and surface mining. A complete PPT ensemble approach should incorporate all of the PPT needed to address all identified hazards. The specific hazards addressed should consider routine exposures such as noise, heat, particulate inhalation from diesel and coal dust, and ergonomic challenges, as well as the emergency hazards for which mine escape respirators (SCSRs) were designed. SCSRs are intended to provide miners with a temporary supply of air for safe escape from roof falls, fires, and other emergencies in underground mines. Advances in communications and individual miner location technology, which are also relevant to firefighters and emergency responders, should be considered. Additional efforts will be necessary to develop effective test methods and per- formance criteria for PPT ensembles. Standardization is needed for the interface between PPT components, so that, for example, eye protection from one manu- facturer is compatible with respirators from another manufacturer. Establishing or Enhancing Workplace Safety Culture Workplaces vary widely in the extent to which worker safety is an innate and valued part of the work culture. Although most U.S. employers are required to follow Occupational Safety and Health Administration (OSHA) regulations on workplace safety and mining employers are required to follow Mine Safety and Health Administration (MSHA) requirements, there are few guidelines to assist e ­ mployers with metrics or indicators to conduct quantitative and qualitative analy- ses of the safety culture and its impact on the use of PPT. From the employer to the supervisor to the worker, a workplace culture that values safety—and consequently 

108 The Personal Protective Technology Program at N I OSH a workplace climate that reinforces the safety culture—provides an environment of cooperation and compliance that supports the establishment of effective adminis- trative controls and proactive safety programs. Although the PPT Program is focused on only one aspect of the workplace safety issue, it is important that NIOSH emphasize systems safety approaches that support the importance of improving all components of workplace safety in order to ensure that each individual PPT component is optimized. The increase in the percentage of contingent and self-employed workers in the workforce presents a significant safety culture challenge. These workers may not be covered by OSHA regulations and may lack training in the selection and wear of PPT equipment. Further research is needed on improving the workplace culture of safety across industries and occupations, and the PPT Program should play a significant lead- ership role in conducting research on how to increase worker adherence to using PPT as a part of its broader efforts. Training and Professional Education The PPT Program’s respirator certification process results in a wide variety of high-quality, commercially available, NIOSH-certified respirators. Additionally, the PPT Program is playing a growing role in ensuring the development of high standards for efficacy of other types of PPT (e.g., gloves). However, the level of pro- tection that this equipment provides the end user depends on how (and whether) it is used and maintained. The level of training, the motivation, and the actions of the end user will determine whether the equipment is being used at all, whether it is used properly, and whether the user is provided with appropriate protection. OSHA regulatory requirements mandate that work sites using respirators provide a respirator training program; best practices in those programs need to be identified and disseminated. An assessment of current training and fit testing programs and respirator use should be carried out by the PPT Program, in collaboration with its many partners, to identify pressing training and educational issues and to develop the materials and programs essential to meet those needs. Efforts are also needed to improve recognition and response to the NIOSH certification seal and to evaluate and improve package inserts and accompanying instructions for all types of PPT. NIOSH is one of many responsible agencies and organizations that can and should provide its substantive expertise in addressing training issues. In 2006, the PPT Program asked the NIOSH Education and Research Centers (ERCs) for information on the extent to which PPT-related topics are incorporated into ERC curricula and professional training. The responses showed some limited efforts in this area but pointed to a substantial need for improved education and professional training on the role of PPT in occupational safety and health. 

Emerging Issues and Research Areas 109 The NIOSH PPT Program should work with OSHA, MSHA, manufacturers, professional associations, and other relevant partners to identify training materi- als needed by employers, employees, and purchasers of all types of PPT. Training materials developed as a result of that effort should be available in multiple for- mats and languages. The PPT Program should increase its collaboration with the NIOSH ERCs to integrate the relevant features of PPT into ongoing training and education efforts. Additional Emerging Issues The committee identified a number of specific issues that it sees as new or expanding areas of research. This is not meant to be an exhaustive list but rather a brief synopsis of some emerging research, standards-setting, and certification challenges. Incorporating Sensor, Telemetry, and Communications Technologies PPT such as SCSRs and firefighter ensembles are often used in emergency or rescue situations, and it is critical to incorporate relevant sensors and systems into this equipment that will allow individual workers to be tracked and aided in escape or will allow others to find them. For example, a detection or telemetry system could be added to an SCSR respirator to identify the time and location at which a miner has begun to use the equipment and any other information that would lead to a more rapid rescue. Usage sensors, indicating the amount of oxygen used, could be devel- oped for SCSRs along with improved sensors for end-of-service-life indicators. The use of PPT equipment often constrains communication between workers. For example, respirators limit the clarity and strength of verbal communication. Thus, advances in communication technologies should also be considered an integral part of the PPT research program. Although these technologies often go beyond the purview of traditional PPT, the committee urges the PPT Program to continue to provide innovative leadership in facilitating partnerships that can assess the entire work environment to identify opportunities for improving the utility of PPT for worker safety within a context that integrates these other important fac- tors, such as communication devices and rescue protocols. Chemical Protective Clothing The needs for research in the area of protection against dermal exposure to hazardous agents have been known for quite a while, but resources have limited progress to date. As discussed in Chapter 2, much less is known about occupational 

110 The Personal Protective Technology Program at N I OSH limits for dermal exposures in comparison with the large body of knowledge and detailed exposure limits for respiratory hazards. It is therefore difficult to select the appropriate dermal protective products and to assess their effectiveness in the workplace. As discussed in earlier chapters, NIOSH (through the PPT Program and the Dermal Exposure Research Program) is involved in research efforts to address some of these concerns. The committee hopes that resources can be found to ad- dress and prioritize research needs for improvements in protective clothing that will reduce exposure to dermal hazards. Filter Media The composition of filter media for respirators has evolved into a complex blend of fibers of various sizes, which in some cases is enhanced with an electrostatic charge to provide the desired filter efficiency. The electrostatic charge on some filter fibers can be dissipated by environmental conditions such as temperature and hu- midity as well as by organic solvents and oils. The PPT Program has recognized the need to examine the effect of workplace conditions such as organic vapor exposure on electrostatic filter performance. A program partnership with North Carolina State University has resulted in a series of articles evaluating the effect of organic chemical exposure on the performance of electrostatic and mechanical fibers and filter media (Jasper et al., 2006; Kim et al., 2006). Further research is needed to develop a more detailed technical understanding of the properties of electrostatic charge on filter media and how it can be dissipated under workplace conditions. Currently filters are tested by NIOSH and certified, but no description of the filter medium is required as part of the certification process. However, filter compo- sition and technology are important in determining how frequently filters need to be replaced. The PPT Program should consider requiring as part of the certification process the respirator manufacturer to provide a description of the filter medium and its limitations, particularly the conditions under which the filtration performance or the filter material itself may degrade. The information should also be made available to purchasers and end users to aid in the selection of respirators and to develop filter change-out schedules. Flow Rates The selection of proper flow rates for testing respirator equipment is impor- tant to worker protection. Flow rate tests are used to simulate the breathing of workers at different work rates in different environments. In devising these tests, there are important trade-offs to be kept in mind. The rates must be high enough 

Emerging Issues and Research Areas 111 to ensure that the equipment provides adequate protection but not so high that they become an unnecessary physiologic burden for the user or an unnecessary work hindrance. For example, to attain high flow rates for powered air-purifying respirators (PAPRs), manufacturers currently rely on a relatively large motor and blower, which, for some occupations such as health care, can seriously interfere with worker communication and mobility. Currently, chemical warfare agent tests for air-purifying respirators, PAPRs, and escape respirators use flow rates of 40 liters per minute (42 CFR 84), as does the flow rate test used to certify self-contained breathing apparatus (SCBA). The National Fire Protection Association (NFPA) standard for SCBAs (NFPA, 2007) required a breathing machine flow rate of 100 liters per minute; this value was identified as the breathing rate of a firefighter working at or near capacity (Burgess, 1976). Increases in the respiratory demand flow rate during intense physical activity need to be further studied particularly regarding their implications for respirators and other forms of PPT (Kaufman and Hastings, 2005). Further research is needed to develop a set of flow rates appropriate to the type of respirator and sensitive to the intended use and physiological demands of potential users. Test protocols that reflect the array of work environments would allow respirator manufacturers to use different design criteria and potentially more efficient filter media. Hazard and Control Framework Employers need to be able to decide what types of controls are needed based on the risks faced by workers. Developing a framework in which to view the re- lationship between exposures and hazards is a recognized need in occupational health that has implications for PPT selection and use. The linkage between haz- ard and control was explicitly made in the National Occupational Hazard Survey (1972-1974) but has not been the subject of recent surveillance activity. Although this work is relevant throughout NIOSH it is important that the PPT Program be involved to ensure that PPT is considered in this effort. One methodology is suggested by “control banding,” a technique that is detailed in a model by the Health and Safety Executive in the United Kingdom (HSE, 2008). Control banding categorizes the type of controls needed to prevent hazardous occupational exposures. The control banding process identifies a single control technology (e.g., general ventilation) that is applicable to a range or band of expo- sure levels to a chemical (e.g., 1 to 10 mg/m3) and that falls within a given hazard group (e.g., skin and eye irritants). Four main control bands have been developed for exposure to chemicals by inhalation (NIOSH, 2008b): 

112 The Personal Protective Technology Program at N I OSH • Band 1: Use good industrial hygiene practice and general ventilation. • Band 2: Use local exhaust ventilation. • Band 3: Enclose the process. • Band 4: Seek expert advice. A framework or guideline for employers and employees would be a significant starting point for informed decision making about environmental, administrative, and PPT controls. Anthropometrics The committee hopes that in the long term, the need for respirator fit testing will be made obsolete by technological breakthroughs in environmental, engineer- ing, or administrative controls or in materials that conform easily to the shape of a variety of faces. However, specific smart technologies may be in the distant future, and there is currently a strong need to further the knowledge base on the anthro- pometric variability of the worker population. Collaboration with other research and practice organizations focused on smart technologies and anthropometric variability is encouraged. The PPT Program sponsored an IOM study (IOM, 2007) specifically focused on these issues and has provided a detailed response to the IOM committee report (NIOSH, 2008c). Emerging areas discussed in that report include replacing the current use of isoamyl acetate with quantitative measures evaluating user seal check, utilizing the panel for certification of filtering facepiece respira- tors, modifications in the certification requirements to encourage manufacturers to develop sizes to fit underrepresented anthropometric categories, and improving the description of face mask sizes in manufacturer’s literature. Development of a clearly defined protocol and sampling frame for three- d ­ imensional imaging is needed. Because of the highly specialized equipment re- quired to conduct anthropometric research, the committee urges the PPT Program to establish cooperative agreements with centers capable of performing three- d ­ imensional imaging. Furthermore, it will be important to develop a central web- based repository for these data that is accessible and easy to use by the research and practice community. Pandemic Influenza In response to the potential for an influenza pandemic and in light of the im- portant role that PPT played in the SARS outbreaks, the PPT Program has begun research to address relevant issues such as mechanisms for decontamination of PPT. Many other important research questions remain. The PPT Program through 

Emerging Issues and Research Areas 113 input from the IOM Committee on Personal Protective Equipment for Workplace Safety and Health requested an IOM study focused on PPT for healthcare work- ers in the event of pandemic influenza that addressed many of the research needs outlined below (IOM, 2008). The PPT Program has recently released an action plan in response to that report (NIOSH, 2008d). Because of the many unknowns regarding transmission of influenza, the com- mittee urges NIOSH and other agencies in the Centers for Disease Control and Prevention (CDC) to expedite research to address a range of short- and long-term needs including the following: • Assessing the viability of virus particles on nondisposable and dispos- able respirators and other PPT • Developing effective decontamination methods—this is particularly critical for healthcare workers who interact with many patients and staff members over the course of a day • Understanding the hazards posed by viral particle size and aerosoliza- tion from a human cough and the impact on the design of PPT • Assessing physiological factors that favor or fail to support N95 use when covered by a surgical mask Nanotechnology Much remains to be learned about the extent to which nanoparticles pose a health hazard. This is an area where NIOSH has moved out ahead of the curve to examine occupational health concerns. The committee did not fully examine the many emerging issues relevant to nanotechnology but urges the PPT Program to continue to keep abreast of efforts in this field and to continue to assess the efficacy of filters and respirators in protecting against exposures to ever-smaller particles. In addition, the PPT Program is encour- aged to ensure that the aforementioned considerations such as human factors and other understudied determinants of effectiveness are taken into account. Surveillance The PPT Program is in the midst of decisions regarding future surveillance activities and a draft PPT surveillance action plan has recently been released (NIOSH, 2008e). Several options for prospective surveillance efforts that may yield focused and useful information come with a fairly significant price tag and would require a long time horizon for data collection and analysis. However, in the judgment of the committee, the protection against survey error and survey bias 

114 The Personal Protective Technology Program at N I OSH that only a ­prospective cohort methodology can provide is likely to be well worth the investment of time, money, and personnel required to obtain such data. Other options under consideration include incorporating PPT data collection into sev- eral ongoing surveys. Additional sources of information stemming from archival administrative records that currently exist should also be considered while awaiting the anticipated data from long-term prospective surveillance. The NIOSH Health Hazard Evaluation Program could be a valuable source of data to inform the PPT Program. Under the HHE Program, NIOSH provides as- sistance to employers or employees in determining whether chemical, physical, bio- logical, or other agents are hazardous as used or found in the workplace. More than 8,000 evaluations have been completed since the inception of the HHE Program in 1972. According to the program’s database, more than 1,000 reports have addressed respiratory hazards and some 640 have addressed dermal hazards (NIOSH, 2008a). These technical reports have often described PPT practices directly observed in the workplace and have made recommendations for appropriate PPT to address the hazards associated with specific exposures. PPT Program staff members have stated that collaborative efforts with the HHE Program are underway. The committee finds value in increased use of this potential resource for improving PPT use in the workplace. The program should focus on developing systematic secondary data analysis methods and working out protocols and frameworks to collect and extract relevant information that can be used in the evaluation and design of PPT. Information from the HHE Program and other sources can eventually be used in the National Occupational Exposure Database, currently under development by NIOSH (NIOSH, 2002). This central repository of occupational exposure-related information will initially hold newly acquired and legacy exposure-related data generated by NIOSH in addition to exposure data from sources outside NIOSH. The database will document, for each sample collected, process and task descrip- tions, engineering controls, PPT in use, and information on analytical methods. In addition, it will contain descriptors of the study facilities, agents, standardized industry and occupational codes, ergonomics, and work organization. The goal is a system that would eventually include end outcome data and would provide valuable surveillance-generated information to inform the PPT Program and other occupational health efforts. REFERENCES American Society of Safety Engineers. 2007. Tales from the front: NIOSH/DoL Working Group on Women and PPE. http://www.asse.org/professionalaffairs/govtaffairs/gaupdate/index.php?issue= 2007-11-13&article=719 (accessed May 20, 2008).  The HHE Program is the subject of a separate National Academies’ evaluation. 

Emerging Issues and Research Areas 115 Burgess, W. H. 1976. Design specifications for respiratory breathing devises for firefighters. Department of Health, Education and Welfare Publication No. 76-121. HSE (Health and Safety Executive). 2008. Easy steps to control health risks from chemicals. http://www. coshh-essentials.org.uk (accessed March 18, 2008). IOM (Institute of Medicine). 2007. Assessment of the NIOSH head-and-face anthropometric survey of U.S. respirator users. Washington, DC: The National Academies Press. IOM. 2008. Preparing for an influenza pandemic: Personal protective equipment for healthcare workers. Washington, DC: The National Academies Press. Jasper, W., J. Hinestroza, A. Mohan, J. Kim, B. Shiels, M. Gunay, D. Thompson, and R. Barker. 2006. Effect of xylene exposure on the performance of electret filter media. Journal of Aerosol Science 47(7):903-911. Kaufman, J. W., and S. Hastings. 2005. Respiratory demand during rigorous physical work in a chemi- cal protective ensemble. Journal of Occupational and Environmental Hygiene 2:98-110. Kim, J., W. Jasper, and J. Hinestroza. 2006. Charge characterization of an electrically charged fiber via electrostatic force microscopy. Journal of Engineered Fibers and Fabrics 1(2):30-46. MSHA (Mine Safety and Health Administration). 2007. Presentation by Laura McMullen, MSHA to the IOM Committee, December 17, 2007. NFPA (National Fire Protection Association). 2007. NFPA 1981: Standard on open-circuit self-contained breathing apparatus (SCBA) for emergency services, 2007 edition. NIOSH (National Institute for Occupational Safety and Health). 2002. Exposure assessment methods: Research needs and priorities. NIOSH Publication Number 2002-126. http://www.cdc.gov/niosh/ docs/2002-126/2002-126.html#Data%20Collection (accessed April 24, 2008). NIOSH. 2007. NIOSH program portfolio, personal protective technology. Emerging issues. http://www. cdc.gov/niosh/programs/ppt/emerging.html (accessed April 8, 2008). NIOSH. 2008a. Health hazard evaluations. http://www.cdc.gov/niosh/hhe/ (accessed April 8, 2008). NIOSH. 2008b. Control banding. http://www.cdc.gov/niosh/topics/ctrlbanding/ (accessed April 24, 2008). NIOSH. 2008c. NPPTL facial anthropometrics research roadmap. http://www.cdc.gov/niosh/review/ public/111/ (accessed March 4, 2008). NIOSH. 2008d. Personal protective equipment (PPE) for healthcare workers action plan. http://www. cdc.gov/niosh/review/public/129/ (accessed March 5, 2008). NIOSH. 2008e. PPT surveillance program action plan. Draft, March 5, 2008 (accessible through the National Academies Public Access File). NRC (National Research Council). 2007. Measuring respirator use in the workplace. Washington, DC: The National Academies Press.