At a glance
- This page provides respiratory protection information and resources for the healthcare sector.
- Hospitals and all other employers who require employees to use respiratory protection must comply with Federal OSHA's Respiratory Protection standard, 29 CFR 1910.134.
- Respirators are designed and regulated to provide a known level of protection when used within the context of a comprehensive and effective respiratory protection program.
Overview
The healthcare environment contains hazards such as bacteria, viruses, and chemicals that may be inhaled by personnel and cause injury or illness. Different types of respirators are designed to provide different levels of protection and to protect against different hazards. Professional judgment along with the type of airborne contaminant, its concentration, its potential to cause a health effect in exposed personnel, and any applicable regulation dictate the type of respirator that must be worn.
The 2007 CDC and Healthcare Infection Control Practices Advisory Committee Guideline serves as a primary resource supporting respirator use policies in healthcare, supplemented by newer guidance issued by CDC, OSHA, public health departments, as well as by relevant scientific literature.
Hospitals and all other employers who require employees to use respiratory protection for control of exposures to hazards in the air must comply with , or the equivalent state standard. The OSHA Respiratory Protection standard establishes legally enforceable requirements about how respirators are to be used.
The approach for reducing exposure required by OSHA and accepted by health and safety professionals is to apply the hierarchy of controls. The use of respiratory protection is an important "last line of defense" in the hierarchy of controls approach.
Terms to know
In order to understand how respirators can be used to protect healthcare personnel, it is important to understand what a respirator is and what it is not. One important distinction that must be made when discussing respirator use in healthcare settings is the difference between respirators and masks. While some people may think respirators and masks are the same, this is incorrect as they are very different in their design, performance, and purpose.
Masks
- Disposable face masks: A mask, with or without a face shield, that covers the user's nose and mouth and may or may not meet fluid barrier or filtration efficiency levels. Face masks should be used by the general public and health care personnel as source control in accordance with CDC recommendations on Infection Control Guidance: SARS-CoV-2, or in other situations as appropriate based on personal circumstances.
- Surgical masks: A mask intended for medical purposes that covers the user's nose and mouth and provides a physical barrier to fluids and particulate materials. Surgical masks are Class II medical devices. These masks meet certain fluid barrier protection standards and flammability requirements (that is, Class I or Class II, per 16 CFR 1610.4). Surgical masks are also tested for particulate and bacterial filtration efficiencies and biocompatibility and are considered personal protective equipment (PPE). While surgical masks may be effective in blocking splashes and large-particle droplets, they do not provide a reliable level of protection from aerosolized particles because of the loose fit between the surface of the mask and your face. Surgical masks are not respiratory protective devices, such as respirators. The NIOSH Science Blog, .
Respirators
Respirators are designed and regulated to provide a known level of protection when used within the context of a comprehensive and effective respiratory protection program. The wearer can then be assured that inhaled air is forced through the filtering material, which allows contaminants to be captured and reduces exposure to both large droplets and small infectious particles. Fit testing is required.
- Respirators: Air purifying respirators, known as respirators, including NIOSH Approved® Filtering Facepiece Respirators (FFRs), such as an N95® FFR and Surgical N95 FFR, filter at least 95 percent of airborne particles. They are PPE that tightly fit the face and provide certain filtration efficiency levels to help reduce wearer exposure to pathogenic particles in a health care setting. They provide a higher level of protection against viruses and bacteria when .
- An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. Note that the edges of the respirator are designed to form a seal around the nose and mouth.
- Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 FFRs, often referred to as N95s.
Respirators used in healthcare
Air-purifying respirators
Air-purifying respirators use filters, cartridges, or canisters to remove gases, vapors, aerosols, or a combination of contaminants from the air. Tight-fitting air-purifying respirators require fit testing prior to use. To help employers select the right protection for a specific contaminant, all filters, cartridges, and canisters must carry a label approved by NIOSH. As a secondary means of identification, cartridges and canisters must also be color-coded as specified by NIOSH.
Air-purifying respirators do not provide clean breathing air from a source independent of the work area; therefore, air-purifying respirators cannot be worn in an oxygen-deficient atmosphere.
Particulate filtering respirators
There are ten classes of NIOSH Approved particulate filtering respirators. These types of respirators use filters to remove particles from the air that is breathed through them. The N, R, and P designations refer to the filter’s oil resistance as shown in the infographic below:
Types of Air-Purifying Respirators
Non-powered, or negative-pressure, respirators have a tight-fitting facepiece, which can be either a half mask that covers the nose and mouth or a full facepiece that covers the nose, mouth, and eyes. They may be disposable (or "single use," meaning the filter is not replaceable and the respirator cannot be cleaned) filtering facepiece respirators where the entire facepiece is made of filtering material, or elastomeric respirators that have replaceable filters or cartridges. The most common types of respirators in healthcare are filtering facepiece respirators and powered air-purifying respirators.
- Filtering facepiece respirators are disposable respirators that cover the nose and mouth.
- Be sure to know "How to Wear Your Filtering Facepiece Respirator", including the process of putting it on (donning) and taking it off (doffing). Filtering facepiece respirators must form a seal to the face. Fit testing is the best way to confirm that a respirator fits you.
- filtering facepiece respirators are required to have appropriate markings to be considered NIOSH Approved.
- You can use NIOSH Approved N95 respirators to reduce your exposures to hazardous particulates in a patient setting. However, you should wear NIOSH Approved surgical N95 respirators when working in a sterile field. If you’re exposed to high-velocity splashes, sprays, or splatters of blood or body fluids, wear a surgical N95 respirator.
- Be sure to know "How to Wear Your Filtering Facepiece Respirator", including the process of putting it on (donning) and taking it off (doffing). Filtering facepiece respirators must form a seal to the face. Fit testing is the best way to confirm that a respirator fits you.
- Elastomeric half mask respirators are reusable respirators and cover the nose and mouth. Learn more on the Elastomeric Respirator Resources page.
- Elastomeric full facepiece respirators are reusable and cover the nose, mouth, and eyes
- Powered air-purifying respirators are reusable and often have a hood or helmet that covers the nose, mouth, and eyes. A battery-powered blower pulls air through filters or cartridges.
Published research
Respirators with an exhalation valve
Healthcare personnel can use a filtering facepiece respirator with an exhalation valve for source control. However, when it is important to maintain a sterile field, Healthcare personnel cannot use a filtering facepiece respirator with an exhalation valve.
Source control refers to the ability to prevent disease transmission to others via the spread of respiratory secretions. A NIOSH report summarizes research on filtering facepiece respirators with an exhalation valve. Findings suggest filtering facepiece respirators with exhalation valves provide the same or better source control than surgical masks or procedure masks. This finding is the same even without covering the valve.
Filtering facepiece respirators with exhalation valves are not fluid resistant. Healthcare personnel should not use these types of respirators in situations requiring a sterile field. For example, during an invasive procedure in an operating or procedure room. The exhalation valve may allow unfiltered exhaled air to escape into the sterile field. In situations requiring a fluid resistant respirator (e.g., in surgical settings), Healthcare personnel should wear a Surgical N95.
Healthcare personnel should not use elastomeric respirators with unfiltered exhalation valves as source control in surgical and other healthcare settings. This is due to concerns that air coming out of the exhalation valve may contaminate the sterile field. The NIOSH Certified Equipment List identifies the elastomeric respirators without exhalation valves or with filtered exhalation valves. Healthcare personnel can use both types in surgical settings.
Healthcare facilities may have their own policies regarding the use of respirators with exhalation valves. Check with your Occupational Health Clinic or Infection Control Staff to understand your facility's policies.
Surgical smoke
Choosing the appropriate respirator for surgical smoke depends on the type of cells and infectious agents contained in the smoke generated during the procedure. You should first incorporate control methods such as ventilation. Ventilation can reduce potential exposure of surgical smoke produced by the use of lasers. See the NIOSH publication below.
For more information on surgical smoke, the Association of periOperative Registered Nurses has , including respiratory protection recommendations.
Active tuberculosis (TB) patients
A NIOSH approved N95 respirator has the minimum filtration performance required when treating patients with suspected or confirmed TB. When the potential for TB exposure is high (i.e., aerosol-generating procedures), healthcare personnel may need a more protective respirator. For more information, see the CDC's:
Research Standards
NIOSH commissioned the National Academies of Sciences, Engineering, and Medicine (to establish the Standing Committee on Personal Protective Equipment (COPPE) in 2005. This committee provides input to Personal Protective Technology (PPT) research standards, conformity assessment, and related activities. The partnership developed the following resources among other products.
Resources and tools
Webinar Recordings
Recordings from the Assessment of Elastomeric Respirators in Healthcare Delivery Settings" webinar series:
Factsheets
Infographics
- N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.