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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1 Introduction P rotecting the health and safety of workers in the United States and globally is accomplished in part by reducing hazardous exposures through the use of personal protective equipment and other protective technologies. Personal protective technologies (PPT) include respirators worn by construction workers and miners to protect against exposure to silica, dust, and hazardous gases; protec- tive clothing, respirators, and gloves worn by firefighters and mine rescue teams to avoid burns and smoke inhalation; and respirators and protective clothing worn by healthcare workers to prevent acquiring an infectious disease. An estimated 5 million workers are required to wear respirators in 1.3 million U.S. workplaces (OSHA, 2007b). For some occupations, such as firefighting, the worker’s protective equipment is the only form of protection against life-threatening hazards; for other workers, PPT is a supplement to ventilation and other environmental, engineering, or administrative hazard controls. In the United States, federal responsibility for civilian worker PPT is integral to the mission of the National Institute for Occupational Safety and Health (NIOSH). This report examines the NIOSH Personal Protective Technology Program (PPT Program) and specifically focuses on the relevance and impact of this program in reducing hazardous exposures and improving worker health and safety. The report also identifies important emerging issues in the future of PPT and closes with recommendations targeted at enhancing personal protective technologies for all workers. 19 

20 The Personal Protective Technology Program at N I OSH SCOPE OF THIS REPORT In September 2004, NIOSH requested that the National Academies conduct evaluation reviews of specific NIOSH programs to assess the relevance and the impact of the work of NIOSH in reducing workplace injury and illness. Further, NIOSH requested that each evaluation study committee be asked to assess and identify emerging research issues for that program and to provide recommenda- tions for program improvement. In response, a set of evaluation studies is being conducted by ad hoc committees of the Institute of Medicine (IOM) and the National Research Council (NRC). Each committee evaluation is using a similar methodology and framework (Appendix A) developed by the National Academies’ Committee to Review NIOSH Research Programs. The framework aims to provide a consistent format across the set of evaluation studies. The Personal Protective Technology Program was one of the programs selected by NIOSH to be included in this series of reviews. In July 2007 the Institute of Medi- cine and the Division on Earth and Life Studies of the National Research Council formed the Committee to Review the NIOSH Personal Protective Technology Program. The committee included members with expertise in occupational health, emergency response, health care, personal protective equipment manufacturing, employee organizations, respiratory protection, dermal protection, injury protec- tion, and program evaluation. The committee was tasked with reviewing the NIOSH PPT Program and evalu- ating the program’s relevance to and impact on occupational health and safety. The task of this committee was slightly modified in comparison with the other evalua- tion committees, so that it included the charge to review the respirator certification program and the standards development efforts of the PPT Program, in addition to reviewing the PPT-related research programs. Specifically the committee was asked to provide the following: • Assessments of the program’s contribution to reductions in workplace hazardous exposures, illnesses, or injuries through ° an assessment of the relevance of the program’s activities to the improvement of occupational safety and health, and ° an evaluation of the impact that the program has had in reducing work-related hazardous exposures, illnesses, and injuries  Because of the addition of the certification and standards elements of the PPT Program, this evaluation also considers additional outcomes such as adoption of new technologies and changes in knowledge, attitudes, and behaviors. 

Introduction 21 • A rating of the performance of the PPT Program for its relevance and impact using an integer score of 1 to 5: Impact could be assessed directly (e.g., reductions in illnesses or injuries) or, as necessary, using intermediate outcomes to estimate impact (qualitative narrative evalu- ations are included to explain the numerical ratings) • Assessments of the program’s effectiveness in targeting new research areas, activities, outputs, and outcomes and identification of emerging issues that the program should be prepared to address • Recommendations for program improvement As explained in more detail later in this chapter, the committee was tasked with focusing its efforts on PPT relevant to respiratory and dermal hazards. The study committee was given the discretion to determine the time period to be covered by the review and chose to focus its evaluation from the inception of the National Personal Protective Technology Laboratory (NPPTL) in 2001 through 2007. The committee held three meetings from September 2007 to March 2008, of which two included open sessions in which the PPT Program was discussed with NIOSH staff, PPT manufacturers, representatives from professional associations and labor unions, and other stakeholders (Appendix B). Additionally, in Novem- ber 2007, committee members participated in a site visit to the PPT Program’s facilities in Pittsburgh, Pennsylvania. CONTEXT AND BACKGROUND Personal protective technologies are defined as the specialized clothing or equipment worn by individuals for protection against health and safety hazards, as well as the technical methods, processes, techniques, tools, and materials that support their development, evaluation, and use (OSHA, 2002; NIOSH, 2007b). PPT encompasses personal protective equipment products such as respirators, gloves, protective eyewear, hearing protection, and protective clothing but also includes facepieces, straps, service life indicators, filters, guidance documents, standards, and test procedures. The brief overview of PPT provided below describes the context of PPT within other occupational safety and health efforts and also highlights the roles of federal agencies and other organizations involved in PPT.  This section draws on text from the 2008 Institute of Medicine report Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. 

22 The Personal Protective Technology Program at N I OSH PPT and Occupational Safety and Health PPT is an essential component in the continuum of occupational safety and health efforts. Although PPT is generally considered as a last line of defense in the hierarchy of protective controls, it is important to note that in many jobs (e.g., fire- fighting), PPT is the only means available to protect workers from serious hazards. PPT is particularly vital for workers who must face hazards in emergency response situations, healthcare workers for protection from infectious agents where the en- vironmental control remains largely undetermined (e.g., SARS, avian influenza), or those who work in outdoor environments or face other conditions in which the work environment is difficult to control (e.g., an influenza pandemic in which large numbers of patients would overwhelm the availability of isolation rooms). In the traditional hierarchy of controls, process changes or substitution are op- timal because they eliminate or reduce the hazard. Engineering and environmental controls (e.g., air exchanges, air filtration, negative-pressure rooms) that can isolate the hazard or reduce exposure or potential for injury are considered the next level of defense against hazardous exposures because they are measures that affect a large number of workers and patients and do not depend on individual compli- ance (Thorne et al., 2004). Administrative controls have been considered the third level of defense because the policies, standards, warnings, alarms, and procedures (including access restrictions, rotating workers to reduce individual exposures, and instilling a culture of workplace safety) established within an organization can substantially limit hazardous exposures and improve worker safety. Although PPT is often considered the last level of defense against hazardous exposures, its impor- tance should not be minimized. The contribution to disease and injury prevention provided by each of these layers of exposure control (including PPT) is likely to vary considerably based on the specific tasks and local conditions.  It is also important to note that personal protective technologies are used by the general public in settings that range from hobbies to home-based businesses to protection against infectious disease. Many employers now provide safety and wellness messages and training for their workforce about being safe outside of work. Thus, the work being done by the NIOSH PPT Program has the potential to go well beyond the workplace. Relevant Agencies and Organizations The testing, regulation, and use of PPT involve a number of government and nongovernmental agencies and organizations. In the federal government, civilian occupational health and safety is the responsibility of both the Department of Health and Human Services (DHHS) and the Department of Labor (DoL). The 

Introduction 23 Occupational Safety and Health Act of 1970 created two federal agencies to address worker safety and health: NIOSH (in DHHS) was designated with responsibilities for relevant research, training, and education, and OSHA (the Occupational Safety and Health Administration in DoL) was designated with responsibilities for de- veloping and enforcing workplace safety and health regulations. NIOSH tests and certifies respirators and conducts and funds research in PPT. NIOSH also plays an integral role in relevant standards setting for many types of PPT (see further details later in this chapter and in Chapter 2). OSHA regulates the use of PPT products in most U.S. workplaces. Respirators used by workers in OSHA- and MSHA (Mine Safety and Health Administration)- regulated workplaces must be certified by NIOSH to meet specific effectiveness criteria. Further, OSHA respirator regulations (29 CFR 1910.134) detail employer responsibilities for establishing and maintaining a comprehensive respiratory pro- tection program, including requirements for performance of a risk assessment to select the proper respirator; annual training; and a program of inspection, cleaning, and disinfection. OSHA also has a general regulatory standard (29 CFR 1910.132) and related regulations for the maritime, construction, and mining industries that govern all other forms of PPT. The federal Occupational Safety and Health Act of 1970 encourages states to develop and operate their own job safety and health pro- grams. Currently, 22 states and jurisdictions operate plans that cover both private- sector and state and local government employees, while 4 states and jurisdictions cover public employees only (OSHA, 2007a). Other departments, agencies, and organizations also have a role in testing and improving PPT. MSHA is actively involved in testing and developing PPT in conjunction with NIOSH for mining applications. The Department of Defense develops and tests PPT for military applications. The Department of Homeland Security focuses on emergency response PPT and works to coordinate and improve standards and equipment-related issues. The Environmental Protection Agency addresses PPT issues relevant to pesticide exposures and emergency response readi- ness. The Consumer Product Safety Commission has oversight responsibilities for PPT products sold in the commercial marketplace. The Food and Drug Adminis- tration (in DHHS) has federal regulatory authority to provide manufacturers with the approval or clearance to market personal protective devices used in health care. PPT products that claim to provide protection against a specific health hazard must have FDA approval or market clearance. For any other PPT products sold in the commercial marketplace, there are no requirements stipulating pre-market or other testing prior to their sale to the public. For those products that assert NIOSH certification, NIOSH has the authority to act against mislabeled products. Federal agencies, PPT manufacturers, employers, and others utilize testing meth- ods and performance requirements for PPT that are based on consensus standards 

24 The Personal Protective Technology Program at N I OSH developed by standards-development organizations such as the International Or- ganization for Standardization. OVERVIEW OF THE NIOSH PPT PROGRAM The PPT Program is 1 of 24 cross-sector programs at NIOSH. Developed in conjunction with the National Occupational Research Agenda (NORA), the NIOSH Program Portfolio is organized both by specific occupational sectors (e.g., construc- tion, manufacturing, mining) and by issues and entities that cut across work sites (e.g., emergency preparedness and response, global collaborations, personal protec- tive technology, hearing loss prevention). The PPT Program’s mission is to “prevent work-related injury, illness, and death by advancing the state of knowledge and application of personal protective technologies” (NIOSH, 2007a). The program’s vision statement follows (NIOSH, 2007a): The vision is to be the leading provider of quality, relevant, and timely PPT research, training, and evaluation. PPT in this context is defined as the technical methods, processes, techniques, tools, and materials that sup- port the development and use of personal protective equipment worn by individuals to reduce the effects of their exposure to a hazard. The PPT Program encompasses the PPT-relevant work conducted within several NIOSH divisions that addresses occupational protection against respi- ratory, dermal, and injury hazards. The NIOSH intramural activities related to PPT to reduce respiratory and dermal hazards are performed primarily within the National Personal Protective Technology Laboratory (NPPTL) (Figure 1-1). O ­ ngoing ­research in the Division of Respiratory Disease Studies intersects with the i ­ nhalation-related research, and work in the Dermal Exposure Research Program interconnects with dermal-related PPT research at NPPTL. Intramural efforts on PPT involved in injury prevention (e.g., hearing loss, fall prevention, antivibration) are performed in the Division of Safety Research, Pittsburgh Research Labora- tory, the Division of Applied Research and Technology, and the Health Effects Laboratory Division. In addition, the PPT Program, like other cross-sector NIOSH programs, is supported by efforts of the Education and Information Division; the Division of Surveillance, Hazard Evaluations, and Field Studies; the Office of E ­ xtramural Programs; and the Health Effects Laboratory Division. Because of the cross-sector and interdisciplinary nature of PPT efforts, the NIOSH PPT Program, established in 2005, has been administered through a matrix management structure that aims to integrate PPT efforts and to implement a col- laborative and cohesive research and policy agenda. Under this matrix structure, the 

Introduction 25 NPPTL director is the responsible manager for the PPT Program and the NPPTL associate director for science is the coordinator for all of the related research activi- ties. The NIOSH cross-sector program alignment in 2005 was the impetus for the development of the PPT Program’s matrix structure (NIOSH, 2007b). The PPT Program has identified three strategic goals: 1. Reduce exposure to inhalation hazards. 2. Reduce exposure to dermal hazards. 3. Reduce exposure to injury hazards. The first two goals are the focus of efforts at NPPTL, while the work on injury hazards is more widely dispersed across several NIOSH divisions. Each of these goals has been further subdivided into a set of objectives determined through the PPT Program’s strategic planning process. The committee was asked to focus on strategic goals 1 and 2 encompassing inhalation and dermal hazards (Box 1-1). Most of the PPT Program objectives related to injury hazards (strategic goal 3) have been examined to some extent by other National Academies’ reviews including the report on the hearing loss research program (IOM and NRC, 2006) and the forthcoming report on the traumatic injury research program. The committee needed to use consistent terminology throughout this report and decided to use the term “PPT Program” to denote the efforts from the inception of NPPTL in 2001 to the present that have been conducted by NIOSH relevant to the 12 PPT objectives that the committee was tasked with examining (Box 1-1). The objectives listed in Box 1-2 include PPT research related to hearing loss, falls, and hand vibration. These efforts are being conducted in several NIOSH divisions (see Figure 1-1) but are not examined in detail in this report because, as noted above, they are addressed in other National Academies’ reviews. PPT Program Efforts The NIOSH PPT Program works to fulfill its mission through three major areas of endeavor: (1) respirator certification, (2) research, and (3) participation in standards setting and policy making. These efforts are interrelated, but each requires appropriate resources and partnering initiatives to be effective. As mentioned above, OSHA- and MSHA-regulated workplaces in the United States with hazardous respiratory exposures must meet federal requirements to  One objective related to strategic goal 3 on warning devices for firefighters was also included in the committee’s purview. 

26 The Personal Protective Technology Program at N I OSH BOX 1-1 PPT Program Strategic Goals and Objectives Strategic Goal 1: Reduce Exposure to Inhalation Hazards Objective 1. Ensure the integrity of the national inventory of respirators through the implementation of a just-in-time respirator certification process. Objective 2. Develop CBRN respirator standards to reduce exposure to CBRN threats. Objective 3. Ensure the availability of mine emergency respirators for escape from mines. Objective 4. Improve reliability and level of protection by developing criteria that influ- ence personal protective equipment designs to better fit the range of facial dimensions of respirator users in the U.S. workforce. Objective 5. Quantify the impacts of various personal protective equipment on viral transmission. Objective 6. Evaluate the nanofiber-based fabrics and NIOSH-certified respirators for respiratory protection against nanoparticles. Objective 7. Develop and make available end-of-service-life indicator (ESLI) technologies that reliably sense or model performance to ensure respirator users receive effective respiratory protection. Objective 8. Gather information on the use of respirators in the workplace to identify research, intervention, and outreach needs. Strategic Goal 2: Reduce Exposure to Dermal Hazards Objective 1. Improve chemical-barrier protective clothing testing and use practices to reduce worker exposure to chemical dermal hazards. Objective 2. Improve emergency responder protective clothing to reduce exposure to thermal, biological, and chemical dermal hazards. Objective 3. Investigate physiological and ergonomic impact of protective ensembles on individual wearers in affecting worker exposure to dermal hazards. Strategic Goal 3: Reduce Exposure to Injury Hazards Objective 1. Develop and evaluate warning devices for fire services. NOTE: CBRN = chemical, biological, radiological, and nuclear. *The PPT Program has additional objectives under this strategic goal that are related to hearing protection, protection from falls, and antivibration technologies (Box 1-2). These objectives are not the focus of this review; some aspects of these objectives have been discussed in other National Academies’ reviews. 

Introduction 27 BOX 1-2 NIOSH PPT Objectives Not Considered as Part of This Review Strategic Goal 3: Reduce Exposure to Injury Hazards Objective 2. Develop measurement and rating methods that are representative of the real-world performance of hearing protection devices. Objective 3. Develop hearing protection laboratory and fit testing methods. Objective 4. Evaluate the effectiveness of hearing protection devices to provide protection from impulsive noise. Objective 5. Develop an integrated hearing protection and communication system. Objective 6. Develop hearing protection recommendations for noise-exposed hearing- impaired workers. Objective 7. Develop and improve fall arrest harnesses. Objective 8. Select and develop vibration isolation devices to reduce hand-arm vibration syndrome. provide their workers with NIOSH-certified respirators. To achieve NIOSH certification, manufacturers submit respirator products to NPPTL, where the products undergo a series of certification tests depending on the type of res- pirator and its ­ intended use (NIOSH, 2007c). Products that successfully meet the ­ design, quality, and performance certification criteria are designated and approved as NIOSH-certified respirators. Federal regulations for NIOSH certi- fication of respirators are outlined in detail in the Code of Federal Regulations (42 CFR Part 84), and any changes to the certification criteria must comply with the federal rule-making process. The PPT Program encompasses both intramural and extramural research components. Intramural research is conducted primarily in the more than 20 laboratory facilities located in Bruceton, Pennsylvania, near Pittsburgh. In addition, research is conducted through contracts with universities and other partners. The NIOSH extramural research program is administered through the NIOSH Office of Extramural Programs and is largely separate from the influence of the intramural program. As described in Chapters 2 and 3, the PPT Program’s research portfolio is focused on PPT for respiratory protection, with a smaller but growing component of research on protective clothing and other types of PPT.  The Mine Safety and Health Administration (MSHA) is also involved in certifying certain mine escape equipment, and the Department of Defense has criteria specific to PPT for the military workforce. 

28 The Personal Protective Technology Program at N I OSH NIOSH Office of the Director National Division of Pittsburgh Division of Division of Health Personal Safety Research Respiratory Applied Effects Protective Research c Laboratory c Disease Research and Laboratory Technology Studiesa Technology c Division a, c Laboratorya , b, c Office of Education and Division of Surveillance, Spokane Extramural Information Hazard Evaluations, and Research Programs a , b, c Division a , b, c Field Studies a , b, c Laboratory FIGURE 1-1  PPT-relevant efforts within the NIOSH organizational structure. In 2005, NIOSH or- ganized its portfolio into programmatic categories that represent industry sectors and cross-sector programs organized around adverse health outcomes, statutory programs, and global efforts. The PPT Program is a cross-sector program that crosses most organizational units. For the scope of this Figure 1-new report, the PPT Program is defined as the work conducted at NPPTL since 2001 related to the 12 objectives described in Box 1-1. Additional units conducting PPT-relevant research are indicated by bolded borders. Units supporting PPT Program activities are indicated by dashed borders. The Office of Extramural Programs funds PPT research grants managed by extramural grant recipients. The Education and Information Division translates PPT research findings to scientific information prod- ucts for dissemination to the workplace. The Division of Surveillance, Hazard Evaluations, and Field Studies conducts workplace investigations to inform the workplace of PPT guidance and regulations and to obtain information on occupational exposures where standards are lacking or do not protect all workers. The Spokane Research Laboratory is not currently conducting any PPT-related efforts. NOTE: aUnit conducts PPT-related efforts relevant to inhalation hazards. bUnit conducts PPT-related efforts relevant to dermal hazards. cUnit conducts PPT-related efforts relevant to injury hazards. NIOSH’s work in PPT also involves participating in the development of rel- evant regulatory standards and consensus standards. Consensus standards for the manufacturing, performance, and testing of PPT products are developed by na- tional and international standards development organizations. These organizations work through expert committees consisting of representatives from government agencies, manufacturers, employers, academia, and end users. PPT Program staff members are involved in efforts of the International Organization for Standard- ization (ISO); ASTM International (formerly, American Society for Testing and Materials); the American National Standards Institute (ANSI); and the National Fire Protection Association (NFPA). History of the PPT Program Efforts by the U.S. government relevant to PPT can be traced back to work by the U.S. Bureau of Mines, which was created in 1910. The Bureau of Mines 

Introduction 29 developed a program of respirator research, performance testing, and analysis and served as the certifying agency for respirators until NIOSH was established in 1971 (NIOSH, 2007b). In the early 1970s, NIOSH and the Bureau of Mines worked jointly to codify the requirements and processes for respirator certification and testing (30 CFR Part 11[12]). In 1972, NIOSH was designated with primary responsibility for the performance testing of respirators. Additionally, NIOSH developed a PPT research program that began to focus on PPT issues relevant to a range of workers including those employed in mining and agricultural work (NIOSH, 2007b). Researchers also assessed the potential use of military gas masks for workplace applications. Prior to 1995, all respirator certifications were issued jointly by MSHA and NIOSH using 30 CFR Part 11 regulations. In 1995, new respirator certification regulations (42 CFR Part 84) were adopted, and NIOSH became the sole approving authority for most respirators. When the U.S. Bureau of Mines was abolished in the mid-1990s, the Pittsburgh Research Laboratory, including its hearing protection research work, was transferred to NIOSH. Respirator certification was housed within the Division of Safety Research through the mid-1990s when it was transferred to the Division of Respiratory Disease Studies. One of the influential efforts in setting PPT research priorities in the first decade of the National Occupational Research Agenda was a 1998 workshop sponsored by NIOSH, the American Industrial Hygiene Associa- tion, and the American Society of Safety Engineers. In 2001, a congressional mandate to expand NIOSH’s occupational safety and health research included a directive for NIOSH to establish a National Personal Protective Technology Laboratory. The congressional intent, as outlined in Senate Report 106-293, stated that [i]t has been brought to the Committee’s attention the need for design, testing and state-of-the-art equipment for this nation’s 50 million min- ers, firefighters, healthcare, agricultural and industrial workers. . . . The Committee encourages NIOSH to carry out research, testing and related activities aimed at protecting workers, who respond to public health needs in the event of a terrorist incident. The Committee encourages CDC [the Centers for Disease Control and Prevention] to organize and implement a national personal protective equipment laboratory. Early efforts at NPPTL, particularly in FY 2001 and FY 2002, were focused on renovating laboratory and office facilities at Bruceton. Respirator certification was transferred from the Division of Respiratory Disease Studies to NPPTL. Additional  Specific mine emergency devices are certified jointly by NIOSH and MSHA. 

30 The Personal Protective Technology Program at N I OSH PPT-related efforts, including PPT for chemical and biological hazards and life support and disaster response, were also transferred to NPPTL. PPT efforts related to reducing exposure to injury hazards (fall harnesses, vibration gloves, hearing protection) remained dispersed across other NIOSH divisions. Most recently in 2005, under the NIOSH cross-sector program alignment, the PPT Program was established. Initial efforts of the PPT Program focused on identifying all PPT- r ­ elated activities in NIOSH. EVALUATION APPROACH Like other IOM and NRC committees that were charged with reviewing the major NIOSH programs (IOM and NRC, 2006; NRC and IOM, 2007, 2008a,b), the com- mittee followed the guidance of the framework developed by the National Academies’ Committee to Review NIOSH Research Programs (Appendix A). This set of guide- lines was used in evaluating the relevance of the program’s work to improvements in occupational safety and health and in assessing the impact that NIOSH efforts have had in reducing workplace illnesses and injuries. The framework committee has suggested that relevance be evaluated in terms of the degree of research priority and connection to improvements in workplace protection. Factors taken into account include the frequency and severity of hazardous exposures, the size of the worker population at risk, the structure of the program, and the degree of consideration given to stakeholder input (see Appendix A). The impact of the program is to be evaluated in terms of its contributions to the end outcomes of worker health and safety and to intermediate outcomes that might reasonably be expected to contribute to reduction in illness and injury over time. The evaluation is to take the form of qualitative nar- rative assessments as well as the assignment of two integer scores between 1 and 5 for the relevance and impact of the Personal Protective Technology Program. The guidance in the Framework Document reflects the terminology and orga- nization of a logic model adopted by NIOSH to characterize the steps in its work. The logic model used by the PPT Program (Figure 1-2) reflects the many roles of the PPT Program, because it includes components related to respirator certification and standards setting as well as those related to research. An examination of goals, inputs, activities, and outputs was used to assess the relevance of the program. End outcomes and intermediate outcomes were the principal focus for the evaluation of the program’s impact. External factors were taken into consideration in the evalu- ation. The terms used in the logic model are defined in Box 1-3. The study charge also directs the committee to review the progress that the PPT Program has made in identifying new research and to provide additional ideas on emerging areas relevant to the program’s mission (Chapter 4). According to the Framework Document, the committee’s identification of emerging research areas 

End Inputs Activities Outputs Customers and Intermediate Outcomes Outcomes PRODUCTION: Funding and staffing; physical infrastructure, INTERMEDIATE Develop and establish Guidance, policies, and including laboratories, CUSTOMERS:: equipment, test fields, criteria, guidelines, recommendations; standards and remote units;* and policy to support NIOSH reports and development managerial standards; conduct guidance documents; organizations; infrastructure, including surveillance; Surveillance; peer-review journal planning and evaluation conduct laboratory other NIOSH articles; other processes and field research; program areas; publications (e.g.,Pocket conduct gap analyses; other U.S. Guide to Chemical PLANNING: agencies; state develop test methods; Hazards); prototypes Standards/ Surveillance and risk and local entities; Changes in assessments; strategic develop new and technology; regulations; technology/ international FINAL workplace planning documents patents; licenses; pilot and/or agencies; NGOs; policies, (e.g., NORA, r2p); prototypes; Prototypes; conduct copyrights; technical market-ready CUSTOMERS:: Reduce authorizing regulations intervention labor, trade, and practices, methods, tools, and technologies; Employers, exposure to (e.g., 42 CFR 84); effectiveness professional and materials; workshops; reports/ workers, and workers legislative mandates; evaluations; conduct associations; PPE procedures; inhalation, meeting presentations; TRANSFER TRANSFER publications; emergency COPPE workforce developers/ adoption of dermal, and report; town hall fit-testing; build education and training training and responders capacity; train and manufacturers; technologies; injury meetings; stakeholder materials; trained education who rely on educate professionals independent test changes in input (e.g., emergency professionals; software; programs; PPE hazards responders, employers, organizations and knowledge, web sites websites media PPE manufacturers), manufacturers); certification attitudes, releases; external Factors (e.g., External factors (e.g., laboratories (e.g., and behavior websites : mine disasters, terrorist SEI, UL); MISSION: illness, and attacks) Responder Develop, revise, and Knowledge Base; * NIOSH laboratories and interpret policies and academic other facilities “accessed” through standards relating to institutions; health grants, cooperative respirator Policies and Standards and safety officers/ agreements, and performance, quality, (42 CFR 84) professionals; contracts reliability, efficacy, and media knowledge and -related injury, personal protectiveadvancing design knowledge and application personal and death by technologies Direct and carry out NIOSH Respirator Respirator certification NIOSH- Certification Program certified To prevent workapplication of of illness, protective technologies the state of respirators Respirators Audit respirators and Investigation reports; Respirator compliance reports; To prevent work -related injury, M ISSION death by advancing the state of undergoing NIOSH manufacturing manufacturers evaluation, process; conduct user notices; recall/ investigation, and/or problem retrofit letter; stop sale Respirators certification processes investigations; long- notice; certification term field evaluations revocation; Respirator Selection Logic; Certified Equipment List Partnerships with standards development organizations (e.g., ISO , ANSI, NFPA, ASTM); other NIOSH program areas; other U.S. agencies (e.g., OSH A, MSHA, OSHA, MSHA, DOD, NIST, DHS); state health and labor departments; local agenc ies; International international agencies and organizations; academic institutions; labor, trade, and professional associations; technology developers/manufacturers; and others Strategic Management Objectives Annual Goals Intermediate Goals Goals External Factors FIGURE 1-2  Logic model for the NIOSH Personal Protective Technology Program. SOURCE: NIOSH, 2007b. 31 Figure 1-1.eps Smallest text is 4.12-pt. 

32 The Personal Protective Technology Program at N I OSH BOX 1-3 Logic Model Terms and Examples Planning Inputs: Stakeholder input, surveillance and intervention data, and risk assess- ments (e.g., input from Federal Advisory Committee Act panels or the National Occupational Research Agenda research partners, intramural surveillance information, Health Hazard Evaluations [HHEs]). Production Inputs: Intramural and extramural funding, staffing, management structure, and physical facilities. Activities: Efforts and work of the program, staff, grantees, and contractors (e.g., surveil- lance, health effects research, intervention research, health services research, information dissemination, training, technical assistance). Outputs: Direct products of NIOSH programs that are logically related to the achievement of desirable and intended outcomes (e.g., publications in peer-reviewed journals, recom- mendations, reports, website content, workshops and presentations, databases, educational materials, scales and methods, new technologies, patents, technical assistance). Intermediate Outcomes: Related to the program’s association with behaviors and changes at individual, group, and organizational levels in the workplace. An assessment of the worth of NIOSH research and its products by outside stakeholders (e.g., production of standards or regulations based in whole or in part on NIOSH research; attendance at training and education programs sponsored by other organizations; use of publications, technologies, methods, or recommendations by workers, industry, and occupational safety and health professionals in the field; citations of NIOSH research by industry and academic scientists). End Outcomes: Improvements in safety and health in the workplace. Defined by measures of health and safety and of impact on processes and programs (e.g., changes related to health, including decreases in injuries, illnesses, or deaths and decreases in exposures due to research in a specific program or subprogram). External Factors: Actions or forces beyond NIOSH’s control (e.g., by industry, labor, regulators, and other entities) with important bearing on the incorporation in the workplace of NIOSH’s outputs to enhance health and safety. SOURCE: Adapted from IOM and NRC, 2006. 

Introduction 33 is to be done using members’ expert judgment rather than a formal research needs assessment. The committee was also charged with providing recommendations for improving the PPT Program (Chapter 5). OVERVIEW OF THIS REPORT The committee provides its assessment of the NIOSH PPT Program in the remaining chapters of this report. Chapter 2 discusses the program’s budget, staff- ing, other production and planning inputs, activities, and outputs and presents the committee’s assessment and rating of the program’s relevance to the priorities of work in PPT. In Chapter 3, the committee examines the intermediate and end outcomes that could reasonably be attributed to the work of the PPT Program and provides its rating of the program’s impact in reducing injury and illness among workers. Chapter 4 reviews the program’s mechanisms for identifying emerg- ing issues and highlights some additional considerations that in the view of the committee warrant future attention. The report concludes in Chapter 5 with the committee’s recommendations for strengthening the PPT Program and increasing its relevance to, and impact on, health and safety in the workplace. REFERENCES IOM (Institute of Medicine). 2008. Preparing for an influenza pandemic: Personal protective equipment for health care workers. Washington, DC: The National Academies Press. IOM and NRC (National Research Council). 2006. Hearing loss research at NIOSH. Committee to Review the NIOSH Hearing Loss Research Program. Rpt. No. 1, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press. NIOSH (National Institute for Occupational Safety and Health). 2007a. Personal Protective Technology Program. http://www.cdc.gov/niosh/programs/ppt/ (accessed March 19, 2008). NIOSH. 2007b. NIOSH Personal Protective Technology Program: Evidence for the National Acad- emies Committee to Review the NIOSH Personal Protective Technology Program. Pittsburgh, PA: NIOSH. NIOSH. 2007c. NPPTL topic: Respirator testing. http://www.cdc.gov/niosh/npptl/stps/respirator_ testing.htm (accessed March 19, 2008). NRC and IOM. 2007. Mining safety and health research at NIOSH. Committee to Review the NIOSH Mining Safety and Health Research Program. Rpt. No. 2, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Acad- emies Press. NRC and IOM. 2008a. Agriculture, forestry, and fishing research at NIOSH. Committee to Review the NIOSH Agriculture, Forestry, and Fishing Research Program. Rpt. No. 3, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press. NRC and IOM. 2008b. Respiratory disease research at NIOSH. Committee to Review the NIOSH Re- spiratory Disease Research Program. Rpt. No. 4, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press.