Addressing the public health gap in respiratory protective devices in the United States.

Abstract

Public health crises like the COVID-19 pandemic and major wildfires have exposed significant confusion about how members of the public can effectively protect themselves from inhaling harmful airborne particles. Unlike many other nations, no single federal agency oversees respiratory protective devices (RPDs) designed for public use against inhaled contaminants. The National Institute for Occupational Safety and Health (NIOSH) currently holds the authority for establishing standards and approving respirators used in workplaces; however, for public sector use, there is a lack of standards for their design and construction, conformity assessment to ensure conformance, risk assessment in selecting devices, and guidance for proper use and maintenance. Without RPDs specifically designed for public use, individuals are left to purchase industrial products intended for workplaces, which do not generally suit the needs of the public, or to rely on domestic and foreign products that have uncertain quality and effectiveness. The development of specific standards for public-use devices, robust conformity assessment practices, and clear guidance on their selection, use, and care is needed. A risk assessment framework for selecting devices for common hazards like wildfire smoke, general air pollution (including pollens and allergens), and infectious particles is presented. Respiratory protection for the public must consider those with physical and mental disabilities and is discussed. Given that nearly all governmental expertise in RPD testing, efficacy determination, and systems oversight resides within NIOSH, its authority could be expanded to assist in developing public-specific standards and conformity assessments. This expansion would enable the public to have confidence that the RPDs they purchase are effective for the protections manufacturers claim.