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NIOSH Continues to Evaluate Use of EHMRs During COVID-19 Pandemic to Inform Future, Routine Use


By Emily J. Haas, PhD, Research Health Scientist, NIOSH NPPTL

Almost a decade ago, the National Institute for Occupational Safety and Health’s (NIOSH) National Personal Protective Technology Laboratory (NPPTL) recognized that a surge in demand for N95 filtering facepiece respirators could outpace supply. Therefore, NIOSH began exploring the use of elastomeric half mask respirators (EHMRs) as an alternative respirator type for routine use or as a potential strategy during supply chain shortages.1 EHMRs are a reusable air-purifying respirator2 with exchangeable cartridge elements that may be selected to provide the needed level of filtration (e.g., N95, P100). The facepieces are made of synthetic or natural rubber material which allows for repeated cleaning, disinfection, storage, and reuse. 

To date, NPPTL has supported several research projects to explore the feasibility of integrating EHMRs into healthcare settings. Funded contracts have studied user acceptability and design improvements, and have supported the development of EHMR implementation guidelines such as those publicly available on the University of Maryland’s website.3 However, the need still exists for research and guidance on EHMR implementation for smaller healthcare settings that have fewer resources, as well as how EHMRs can be included in respiratory protection programs (RPPs) to support long-term use. 

Back in 2020, NPPTL and the Strategic National Stockpile (SNS) discussed the need for a nationwide deployment strategy for procuring and distributing EHMRs to healthcare settings. To gain feedback from organizations about these topics, NPPTL posted a Federal Register Notice open for public comment.4 In June 2021, the SNS began purchasing EHMRs without exhalation valves or with filtered exhalation valves—as well as their corresponding particulate filters—for deployment to interested organizations. In total, almost 150,000 EHMRs were requested from the SNS, with a wide range of units being requested based on an organization’s size and need. The average request from healthcare settings was approximately 4,000 EHMRs with the range being 10 to 34,000. 

NPPTL used this initiative to implement EHMR demonstration studies among 43 of the organizations (as of this blog being published) that received EHMRs from the SNS and had separately expressed their willingness to participate in a NIOSH study (e.g., hospital systems, dental clinics, ambulatory units, county health systems). Activities are well underway with most of the organizations having completed or begun fit testing their employees in a variety of job roles, including doctors, nurses, dentists, dental hygienists, and emergency medical service personnel.

NPPTL researchers are currently collecting and analyzing data on organizational experiences during EHMR implementation, updates made to RPPs, management practices to support EHMRs, and user perceptions and preferences. To do this, researchers are distributing online surveys to individual users and are conducting interviews with management. While these activities remain in progress, the team has gathered some preliminary data points to share:

  • Initial survey results show inconsistent access to respiratory protection, with 47% of respondents to date indicating access issues. This is an important data point because difficulty accessing adequate personal protective equipment (PPE) has been linked to healthcare worker anxiety and depression.5 The integration of reusable respirators, whether stockpiled for emergencies or routine use, can reduce access barriers and hopefully alleviate worker stress.
  • EHMR users who did not know about their organization’s RPP had lower perceptions of their organization’s support for their own health and well-being on the job. With initial survey results showing that 52% of users who completed the survey were not familiar with RPPs, management can play an important role in communicating the purpose and use of these programs. During interviews with management, the role of transparent communication has been discussed in several capacities from written RPPs to consistent training to realistic expectations about EHMR use during work tasks.

While preliminary, these findings have already led some participating organizations to ensure their employees become knowledgeable about their own RPP and to communicate the value of reusable respirators in the workplace. Researchers are using the feedback to develop and enhance several EHMR information products including implementation guidelines and sustainability practices to support EHMR use during routine operations. These efforts include the identification of beneficial PPE management practices to consider when introducing and supporting the use of alternative or new types of respiratory protection during routine and public health emergencies. These activities also aim to support research-to-practice interventions that consider worker well-being as an outcome measure when introducing new technologies, processes, and practices into the workplace.

For specific questions about this project, please contact: .

References Cited

  1. Centers for Disease Control and Prevention (CDC) Convention, Contingency, and Crisis Strategies for Elastomeric Respirators 
  2. NIOSH EHMR Resources Landing Page
  3. University of Maryland Implementation Guide to Support Use of Elastomeric Half Mask Respirators in Healthcare
  4. NIOSH EHMR Strategy Federal Register Notice
  5. Arnetz JE, Goetz CM, Sudan S, Arble E, Janisse J, Arnetz BB [2020]. Personal protective equipment and mental health symptoms among nurses during the COVID-19 pandemic. Journal of Occupational and Environmental Medicine 62(11): 892-897.

Disclaimer: The findings and conclusions are those of the author and do not necessarily represent the official position of the NIOSH, CDC. 

Emily J. Haas, PhD, is a Research Health Scientist at the National Personal Protective Technology Laboratory (NPPTL), a division of the National Institute for Occupational Safety and Health (NIOSH), which operates within the Centers for Disease Control and Prevention (CDC). Dr. Haas directs multi-level research projects that guide high-risk industries to identify and adopt best practices within their occupational safety and health (OSH) management systems such as employee engagement and safety culture enhancement to improve the integration and safe adoption of new OSH technologies.