The National Institute for Occupational Safety and Health recommends the use of nitrile gloves with a minimum thickness of 5.0 ± 2.0 mil [0.127 ± 0.051 millimeters] in situations where it is suspected or known that fentanyl or other illicit drugs are present. However, there is limited data available on fentanyl permeation through gloves. Current test methods used to measure fentanyl permeation do not consider the effect of glove fit and flexion. Furthermore, first responders need to have PPE readily available in the field, and storage conditions may affect the protective performance of the gloves. The objective of this study was to evaluate the effects of glove stretch and storage temperatures on glove durability and barrier performance against fentanyl. Nine nitrile glove models previously shown to be resistant to fentanyl permeation were selected for this investigation. These nine models were stretched 25% in one linear direction, to consider glove fit and flexion, and tested against fentanyl hydrochloride permeation. Additionally, four of the nine glove models were stored at 48 °C, 22 °C, and -20 °C, and evaluated for tensile strength, ultimate elongation, and puncture resistance after up to 16 wk of storage and fentanyl permeation after up to 8 wk of storage. At least one sample for six of the nine tested models had maximum permeation over the test method fail threshold when stretched. The tested storage temperatures showed no effect on glove tensile strength, ultimate elongation, and puncture resistance. The findings of this study can be used to inform PPE recommendations, with consideration to storage practices and proper sizing for first responders with potential exposure to fentanyl and other illicit drugs. The results of this study can be used to assess the need for new standard test methods to evaluate the barrier performance of gloves and shelf-life determination with consideration to glove fit.

Reusable elastomeric half mask respirators (EHMRs) have been encouraged for use during conventional, contingency, and crisis capacity in healthcare delivery settings as an alternative to disposable N95 filtering facepiece respirators (FFRs). However, standard, operationalized guidelines for implementing EHMRs in healthcare and first responder settings are needed to facilitate such integration. Specifically, research is needed to identify and address specialized concerns in healthcare delivery settings beyond hospitals to understand the widespread barriers to EHMR use and how organizational culture can support or hinder EHMR adoption. The Strategic National Stockpile (SNS) requested support from the National Institute for Occupational Safety and Health (NIOSH) to develop its strategy to purchase and distribute EHMRs to interested health organizations. To support this SNS effort, NIOSH published a Federal Register Notice (FRN) to request formative input from the public on the nationwide distribution of EHMRs and provided the technical analysis of the responses. Twenty-two representatives from first responder organizations, healthcare and dental associations, manufacturers, higher education, medical/nursing societies, and a union provided comments for consideration. This feedback was qualitatively analyzed to identify themes among the comments. This paper discusses patterns that emerged in the feedback provided within the primary topics of perceived advantages and disadvantages of EHMRs and key considerations for a successful national deployment of EHMRs. This paper also discusses how the formative feedback received was critical to informing the SNS's strategy to purchase and deploy EHMRs for longitudinal demonstration projects with the goal to produce updated EHMR implementation guidelines and best practices.

An increase in reusable elastomeric half mask respirators among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.

During public health emergencies such as an influenza pandemic, disposable filtering facepiece respirator (FFR) shortages have a significant impact on the national response, affecting many types of workplaces that rely on respiratory protection. During the COVID-19 pandemic, severe FFR shortages led the CDC to publish strategies for optimizing the supply of N95 FFRs. These strategies included the extended use and limited reuse of FFRs, wearing decontaminated FFRs, wearing respirators that meet an international respirator standard, or wearing FFRs that were past their manufacturer-designated shelf life. An additional strategy to mitigate supply shortages that was highlighted during the COVID-19 pandemic was to wear reusable respirators, such as elastomeric half mask respirators (EHMRs), or powered air-purifying respirators, which can be cleaned, disinfected, and reused. A decade of nationwide initiatives to increase the utility of EHMRs in healthcare settings were realized during the COVID-19 pandemic as EHMRs became more well-known and were used in healthcare settings for respiratory protection. This expanded use of EHMRs led to an increase in federal procurement, research, guidance, and private sector research and development of innovative EHMR designs by manufacturers to respond to workers' needs for both respiratory protection and source control. This paper describes the role of reusable EHMRs before and during the COVID-19 pandemic, and reviews past and current research, to inform successful EHMR implementation in healthcare and first responder settings.

PROBLEM: Safety management literature generally categorizes key performance indicators (KPIs) as either leading or lagging. Traditional lagging indicators are measures related to negative safety incidents, such as injuries, while leading indicators are used to predict (and therefore can be used to prevent) the likelihood of future negative safety incidents. Recent theory suggests that traditional lagging indicators also possess characteristics of leading indicators, and vice versa, however empirical evidence is limited. METHOD: The current research investigated the temporal relationships among establishment-level injuries, near misses, and fatal events using injury and employment data from a sample of 24,910 mining establishments over a 12-year period. RESULTS: While controlling for employee hours worked, establishment-level reported injuries and near misses were associated with of future fatal events across the sample of mines and over the time period studied. Fatal events were also associated with increases in future reported near misses, providing evidence of a cyclic relationship between them. DISCUSSION: These findings challenge the strict categorization of injuries, near misses, and fatal events as lagging indicators. Practical applications: Understanding the KPIs that should be used to manage organizational safety, and how they can be used, is of critical practical importance. The results of the current study suggest that, depending on several considerations, metrics tied to negative safety incidents may be used to anticipate, and possibly prevent, future negative safety events.

In the event of a chemical, biological, radiological, or nuclear (CBRN) hazard release, emergency responders rely on respiratory protection to prevent inhalation of these hazards. The National Institute for Occupational Safety and Health's (NIOSH) CBRN Statement of Standard calls for CBRN respirator canisters to be challenged with 11 different chemical test representative agents (TRAs) during certification testing, which represent hazards from 7 distinct Chemical Families; these 11 TRAs were identified during the original 2001 CBRN hazard assessment. CBRN hazards are constantly evolving in type, intent of use, and ways of dissemination. Thus, new and emerging hazards must be identified to ensure CBRN canisters continue to provide protection to emergency responders against all hazards that would most likely be used in an intentional or unintentional event. The objectives are to: (1) update the CBRN list of hazards to ensure NIOSH-approved CBRN canisters continue to provide adequate protection capabilities from newly emerging chemical and radiological hazards and (2) identify the need to update NIOSH TRAs to ensure testing conditions represent relevant hazards. These objectives were accomplished by reviewing recent hazard assessments to identify a list of chemical and radiological respiratory hazards, evaluate chemical/physical properties and filtration behavior for these hazards, group the hazards based on NIOSH's current Chemical Families, and finally compare the hazards to the current TRAs based on anticipated filtration behavior, among other criteria. Upon completion of the evaluation process, 237 hazards were identified and compared to NIOSH's current CBRN TRAs. Of these 237 hazards, 203 were able to be categorized into one of NIOSH's current seven Chemical Families. Five were identified for further evaluation. Based on reviewing key chemical/physical properties of each hazard, NIOSH's current 11 TRAs remain representative of the identified respiratory CBRN hazards to emergency responders and should continue to be used during NIOSH certification testing. Thus, NIOSH's CBRN Statement of Standard remains unchanged. The process developed standardizes a methodology for future hazard evaluations.

Although researchers have struggled to replicate Heinrich’s safety triangle findings (Heinrich 1931) for various reasons (e.g., no access to his original database and it is unclear if the database was of a single establishment/operation or for an entire industry), the occupational safety community has continued to adopt and expand the applications of this theory (e.g., McSween 2003). Within the mining industry, the potential exists for operations and companies to use concepts from the safety triangle as a way to inform or challenge the practices employed within their health and safety management systems (HSMS) to prevent incidents (Backlund 2016). This paper considers data obtained from the Mine Safety and Health Administration’s databases and demonstrates the validity of applying the safety triangle theory at the mine level. The results support the use of this theory and demonstrate that lower severity incidents can predict fatalities in a subsequent year where significant nuances and caveats to applying the theory are identified and discussed.

In 2018, the Centers for Disease Control and Prevention reported that opioid overdose deaths (including fentanyl and carfentanil) comprised 46,802 (69%) of the 67,367 total drug overdose deaths. The opioid overdose epidemic affects Americans not only at home but also in the workplace. First responders may be at risk of opioid exposure during incidents such as vehicle searches and responses to overdose calls. To reduce direct exposure to opioids and other hazardous drugs, first responders rely in part on personal protective equipment (PPE) as their last line of defense. First responders seek guidance from the National Institute for Occupational Safety and Health (NIOSH) regarding appropriate PPE selection for potential opioid exposure. There is limited empirical glove performance data for illicit drugs. Empirical data are needed to validate NIOSH's current recommendations regarding gloves to help prevent exposure to illicit drugs (i.e., powder-free nitrile gloves with a minimum thickness of 5 +/- 2 mil [0.127 +/- 0.051 millimeters]); however, no industry standard or test method currently exists for specifically evaluating PPE performance against fentanyl and its analogs. To understand the permeation qualities of gloves when challenged against fentanyl and carfentanil solutions, the ASTM International (formerly American Society for Testing and Materials) ASTM D6978-19 standard for chemotherapy drug glove permeation was adapted to test fentanyl and carfentanil hydrochloride solution permeation through twelve disposable glove models, including five models in which the manufacturers claim fentanyl protection. No nitrile glove models showed fentanyl or carfentanil permeation rates above the chemotherapy drug threshold criterion of 0.01 microg/cm(2)/min (i.e., thereby meeting the performance requirement) as calculated using the ASTM D6978-19 standard within the 240-min test. Latex and vinyl glove materials exhibited fentanyl and carfentanil permeation with permeation rates above this threshold. These findings are among the first empirical data to support NIOSH's current opioid glove recommendations and define procedures that could be used to support industry standards for evaluating opioid permeation through air-impermeable PPE materials.

BACKGROUND: Personal protective equipment (PPE) are stockpiled across the nation to offset supply depletion during public health emergencies. Stockpiled PPE inventories vary across the U.S. by type, model, quantity, and the conditions in which they are stored. Over the past decade, federal, state, and local stockpile managers have had concerns for the viability of aging PPE. METHODS: To understand factors that may affect stockpiled PPE, we explored the breadth of stockpile storage conditions and respirator and surgical gown inventories through collaboration with the national PPE community, qualitative observations collected at 10 different U.S. stockpiles, and by compiling stockpile PPE inventories and climate data from a convenience sample of U.S. stockpiles. RESULTS: The aggregated inventory from 20 stockpiles is reported, accounting for approximately 53 million respirators. Most respirators (69% or 35.8 million) have been stored between 5 and 10 years. Upon visiting 10 stockpile facilities, we report on the storage conditions observed and summarize the storage environment data collected. CONCLUSIONS: This is the first study to identify common PPE types, inventories, and storage conditions across federal, state, and local government stockpile facilities as well as healthcare organization-managed caches. These findings will be leveraged to guide the development of sampling protocols for air-purifying respirators and surgical gowns in U.S. stockpiles to understand the performance viability after long-term storage.

During a public health emergency, respirator shortages can have a profound impact on the national response, such as for the current coronavirus disease 2019 (COVID-19) pandemic. Due to a severe shortage of respirators (particularly filtering facepiece respirators [FFRs]), there may be contexts in which understanding the performance of FFRs that are approved for use as part of a crisis capacity strategy is desired. This includes FFRs that are not covered under the National Institute for Occupational Safety and Health (NIOSH) Respirator Approval Program because they have been stored past their designated shelf life, have been decontaminated, or are approved by international certification bodies other than NIOSH. The purpose of this document is to provide a general framework to assess the performance of FFRs that are only being used as a crisis capacity strategy. The intended audience are those who are responsible for managing large amounts of FFRs. This framework includes a four-step process consisting of: 1) defining the population of FFRs to be sampled; 2) providing sampling strategy options; 3) inspecting and testing the sampled units; and 4) evaluating the results. In addition to the four-step process, we provide an example of how NIOSH recently evaluated the quality of FFRs sampled from ten U.S. stockpiles.

Given the recent increase in dust-induced lung disease among U.S. coal miners and the respiratory hazards encountered across the U.S. mining industry, it is important to enhance an understanding of lung disease trends and the organizational contexts that precede these events. In addition to exploring overall trends reported to the Mine Safety and Health Administration (MSHA), the current study uses MSHA's enforcement database to examine whether or not compliance with health regulations resulted in fewer mine-level counts of these diseases over time. The findings suggest that interstitial lung diseases were more prevalent in coal mines compared to other mining commodities, in Appalachian coal mines compared to the rest of the United States, and in underground compared to surface coal mines. Mines that followed a relevant subset of MSHA's health regulations were less likely to report a lung disease over time. The findings are discussed from a lung disease prevention strategy perspective.

An inexpensive red, green, blue (RGB) color sensor was developed for detecting low ppm concentrations of hydrogen cyanide gas. A piece of glass fiber filter paper containing monocyanocobinamide [CN(H2O)Cbi] was placed directly above the RGB color sensor and an on chip LED. Light reflected from the paper was monitored for RGB color change upon exposure to hydrogen cyanide at concentrations of 1.0-10.0 ppm as a function of 25%, 50%, and 85% relative humidity. A rapid color change occurred within 10 s of exposure to 5.0 ppm hydrogen cyanide gas (near the NIOSH recommended exposure limit). A more rapid color change occurred at higher humidity, suggesting a more effective reaction between hydrogen cyanide and CN(H2O)Cbi. The sensor could provide the first real time respirator end-of-service-life alert for hydrogen cyanide gas.

An inexpensive paper-based sensor was developed for detecting low ppm concentrations of hydrogen sulfide gas. A piece of filter paper containing aquohydroxocobinamide [OH(H2O)Cbi] was placed on the end of a bifurcated optical fiber, and the reflectance spectrum of the OH(H2O)Cbi was monitored during exposure to 10.0 ppm hydrogen sulfide gas (NIOSH recommended exposure limit). Reaction of sulfide (HS-) yielded an increase in reflectance from 400-450 nm, and decrease from 470-550 nm. Spectral changes were monitored as a function of time at 25, 50, and 85% relative humidity. Spectral shifts at high-er humidity suggested reduction of the Cbi(III) compound. The sensor was used to detect hydrogen sulfide breakthrough from respirator carbon beds and results correlated well with a standard electrochemical detector. The simple paper-based sensor could provide a real-time end-of-service-life alert for hydrogen sulfide gas. by Elsevier B.V.

We describe an inexpensive paper-based sensor for rapid detection of low concentrations (ppm) of hydrogen cyanide gas. A piece of filter paper pre-spotted with a dilute monocyanocobinamide [CN(H2O)Cbi] solution was placed on the end of a bifurcated optical fiber and the reflectance spectrum of the CN(H2O)Cbi was monitored during exposure to 1.0-10.0 ppm hydrogen cyanide gas. Formation of dicyanocobinamide yielded a peak at 583 nm with a simultaneous decrease in reflectance from 450-500 nm. Spectral changes were monitored as a function of time at several relative humidity values: 25, 50, and 85% relative humidity. With either cellulose or glass fiber papers, spectral changes occurred within 10 s of exposure to 5.0 ppm hydrogen cyanide gas (NIOSH recommended short-term exposure limit). We conclude that this sensor could provide a real-time end-of-service-life alert to a respirator user.