Employee Protection > Nonpharmaceutical Interventions
Last reviewed Aug 1, 2011
Overview
Recent Additions
NEW: H1N1 Lessons Learned
Articles from Weekly Briefing/Osterholm Briefing
Resources from Others
Background
Guidelines
Social Distancing
Personal Protective Equipment (PPE)
Overview
During an influenza pandemic or other infectious disease emergency, a number of nonpharmaceutical (nondrug) measures will be considered in addition to vaccines and antiviral drugs. Examples include isolation and quarantine, social distancing (keeping physical space between people in public), use of masks or respirators by the general public and/or in work settings (outside of healthcare settings), handwashing, and cough/sneeze etiquette. Keep in mind, though, that data assessing the effectiveness of these interventions are limited and experts debate their value.
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Recent Additions
Borse RH, Behravesh CB, Dumanovsky T, et al. Closing schools in response to the 2009 pandemic influenza A H1N1 virus in New York City: economic impact on households. Clin Infect Dis 2011 Jan 1;52(suppl 1):S168-S172 [Full text]
IOM (Institute of Medicine). Preventing transmission of pandemic influenza and other viral respiratory diseases: personal protective equipment for healthcare personnel update 2010. Jan 27, 2011 [Full text]
Simmerman JM, Suntarattiwong P, Levy J, et al. Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission. Clin Infect Dis 2010 (published online Sep 27) [Abstract]
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H1N1 Lessons Learned
Borse RH, Behravesh CB, Dumanovsky T, et al. Closing schools in response to the 2009 pandemic influenza A H1N1 virus in New York City: economic impact on households. Clin Infect Dis 2011 Jan 1;52(suppl 1):S168-S172 [Full text]
Chao DL, Halloran ME, Longini IM. School opening dates predict pandemic influenza A(H1N1) outbreaks in the United States. J Infect Dis 2010 (published online Aug 12) [Abstract]
Lee VJ, Yap J, Cook AR, et al. Effectiveness of public health measures in mitigating pandemic influenza spread: a prospective sero-epidemiological cohort study. J Infect Dis 2010 (published online Sep 23) [Abstract]
Sikora C, Fan S, Golonka R, et al. Transmission of pandemic influenza A (H1N1) 2009 within households: Edmonton, Canada. J Clin Virol 2010 (published online Jul 29) [Abstract]
Simmerman JM, Suntarattiwong P, Levy J, et al. Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission. Clin Infect Dis 2010 (published online Sep 27) [Abstract]
Murray M, Grant J, Bryce E, et al. Facial protective equipment, personnel, and pandemics: impact of the pandemic (H1N1) 2009 virus on personnel and use of facial protective equipment. Infect Control Hosp Epidemiol 2010 (published online Aug 23) [Abstract]
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Articles from Weekly Briefing/Osterholm Briefing
FDA approves 2 respirators for disease protection
The Food and Drug Administration says two new 3M models will be available to the public, including businesses, without a prescription.
CDC advises on when masks, respirators might help in a pandemic
If you don't have these devices for your employees at the beginning of an outbreak, good luck. The supply will never come close to meeting the demand once a pandemic begins.
Study: Three fourths don't wear respirators correctly
Real-world study from Hurricane Katrina shows the importance of training employees on how to wear these respiratory-protection devices.
Review: Airborne spread of influenza unlikely, but questions remain
A recent review provides key guidance for determining which protection equipment is worth investing in for workers (N-95 respirators for aerosols, masks for droplets, gloves for contact transmission).
Questions raised about study on masks as aerosol barrier
A recent study appears to show that masks may protect as well as N-95 respirators in a pandemic, but the evidence is far from conclusive. A combination of the two devices may be your best bet.
Dodging the 'magic bullet' syndrome
Commentary from Michael Osterholm on above study.
OSHA's pandemic influenza guidance: Low-risk advice for high-stakes sectors
Which employees are considered at risk and would benefit most from personal protective equipment that is in short supply?
Planning for pandemic-protection shortages
Sidebar to above article on how to plan for such shortages.
Respirators and facial hair: What preparedness planners need to know if employees can't or won't shave
Ways around roadblocks presented by those whose religion or skin condition may discourage them from shaving before donning N-95 respirators.
HHS ties pandemic response guidelines to outbreak severity
Every business professional and trade organization should be involved at the local or state level about how to apply these measures in your community.
Can common sense stop the spread of pandemic flu?
All about face masks and respirators; isolation, quarantine, and sequestration; staying home; respiratory etiquette; and hand washing.
More specifics on employees' respirator use
Follow up to article listed below, with updated information from new OSHA report.
Masks? Respirators? How should businesses prepare?
Explores the scientific evidence that seems to indicate that respirators will afford more protection than masks but points out the supply issues for both.
Making sense of mask and respirator use for employee protection
Sidebar to article above. Details the difference between the two devices and discusses how influenza viruses are likely spread.
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Resources from Others
Background
The American Cleaning Institute. A survey of handwashing behavior (trended). Aug 2010 [Full text - PDF]
Bloomfield S, Exner M, Fara GM, et al. Prevention of the spread of infection - the need for a family-centred approach to hygiene promotion. Eurosurveillance 2008 May 29;13(22) [Full text]
Department of Health and Health Protection Agency (UK) in collaboration with the Health and Safety Executive, Department for Business, Enterprise and Regulatory Reform and Cabinet Office. Pandemic flu guidance for businesses: risk assessment in the occupational setting. Released Mar 27, 2009 [Web site]
This booklet explains how businesses can help reduce the spread of flu in the event of a pandemic. It provides information to allow businesses to assess the types of measures that may be used in their particular occupational setting.
Ebrahim SH, Memish ZA, Uyeki TM, et al. Pandemic H1N1 and the 2009 Hajj. Science. 2009;326(5955):938. [Abstract]
De Serres G, Rouleau I, Hamelin ME, et al. Contagious period for pandemic (H1N1) 2009. Emerg Infect Dis 2010 May (published online Apr 2) [Full text]
Duerr HP, Brockmann SO, Piechotowski I, et al. Influenza pandemic intervention planning using InfluSim: pharmaceutical and non-pharmaceutical interventions. BMC Infect Dis 2007;7:76 (published online Jul 13) [Full text - PDF]
Harvard Opinion Research Program (Harvard School of Public Health). Employers took many measures to protect employees and avoid business impact of H1N1 flu outbreak. Poll results released Jun 22, 2010 [Full text]
Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci 2007 (published online Apr 6) [Abstract, with access to free full text]
IOM. Committee on the development of reusable facemasks for use during an influenza pandemic. (Meeting 1) Jan 23, 2006 [Web page]
IOM. Committee on the development of reusable facemasks for use during an influenza pandemic. (Meeting 2) Apr 11, 2006 [Web page]
IOM. Committee on personal protective equipment for healthcare workers during an influenza pandemic. (Meeting 2) Feb 22, 2007 [Web page]
IOM. Modeling community containment. Workshop. Oct 25-26, 2006 [Web page]
IOM. Modeling community containment for pandemic influenza: a letter report. Released Dec 11, 2006 [Full text]
IOM. Reusability of facemasks during an influenza pandemic: facing the flu. 2006 [Full text]
Jefferson T, Foxlee R, Del Mar C, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2008 Jan 12;336(7635):77-80 [Full text]
Lemon SM, Hamburg MA, Sparling PF, et al. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary. Book from Board on Global Health and Institute of Medicine released Jun 11, 2007 [Full text]
Low DE. Pandemic planning: non-pharmaceutical interventions. Respirology 2008 Mar;13(s1):S44-8 [Abstract]
Pall Corporation. Pandemic preparedness: a global webinar on transmission of influenza and other infectious diseases - the role of breathing filters in the clinical setting. Jan 18, 2006 [Webinar]
Rothstein MA, Talbott MK. Encouraging compliance with quarantine: a proposal to provide job security and income replacement. Am J Public Health 2007 (published online Apr 5) [Abstract]
Shaw FE, McKie KL, Liveoak CA, et al. Variation in quarantine powers among the 10 most populous US states in 2004. Am J Public Health 2007 (published online Apr 5) [Abstract]
Swaminathan A, Martin R, Gamon S, et al. Personal protective equipment and antiviral drug use during hospitalization for suspected avian or pandemic influenza. Emerg Infect Dis 2007 Oct;13(10) (published online Sep 5) [Full text]
Trust for America's Health. Pandemic flu: lessons from the frontlines. Jun 4, 2009 [Links to press release and full report]
Vukotich CJ Jr, Coulborn RM, Aragon TJ, et al. Findings, gaps, and future direction for research in nonpharmaceutical interventions for pandemic influenza. (Conference summary) Emerg Infect Dis 2010 Apr;16(4):e2 [Full text]
Wang TH, Wei KC, Hsiung CA, et al. Optimizing severe acute respiratory syndrome response strategies: Leassons learned from quarantine. Am J Public Health 2007 (published online Apr 5) [Abstract]
WHO Writing Group. Nonpharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis 2006 Jan;12(1) [Full text]
WHO Writing Group. Nonpharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis 2006 Jan;12(1) [Full text]
WHO. Ethics of public health measures in response to pandemic influenza. Project on addressing ethical issues in pandemic influenza planning, working group two. Oct 6, 2006 [Full text - PDF]
Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus. Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med 2008 Jan 17;358(3) [Full text]
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Guidelines
CDC/HICPAC. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings [Web page]
CDC. Cover Your Cough [Web page]
CDC. Interim CDC guidance on day and residential camps in response to human infections with the novel influenza A (H1N1) virus. June 14, 2009 [Full text]
CDC. Interim CDC guidance for nonpharmaceutical community mitigation in response to human infections with swine influenza (H1N1) virus. Apr 28, 2009 [Full text]
CDC. Interim guidance for public gatherings in response to human infections with novel influenza A (H1N1). Sep 23, 2009 [Full text]
CDC. Interim public health guidance for the use of facemasks and respirators in non-occupational community settings during an influenza pandemic. Released May 3, 2007 [Full text]
CDC. Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States--early, targeted, layered use of nonpharmaceutical interventions. Released Feb 1, 2007 [Full text]
CDC. Interim recommendations for facemask and respirator use to reduce 2009 influenza A (H1N1) virus transmission. Sep 24, 2009 [Full text]
CDC. Respiratory hygiene/cough etiquette in healthcare settings [Web page]
CDC. What you should know about using facemasks and respirators during a flu pandemic. Released May 3, 2007 [Full text]
DOD. Pandemic influenza: clinical and public health guidelines for the military health system. May 17, 2007 [Full text - PDF]
FDA. Dear Health Care Professionals: 2009 H1N1 flu virus. (Letter) (published online May 7) [Full text]
HHS. Interim guidance for cargo trucking crews for the prevention of pandemic influenza. Mar 23, 2009 [Full text]
This draft interim guidance is meant to inform and educate cargo trucking management and crew personnel about precautions and appropriate work practices to minimize exposure and prevent workplace-related transmission of flu in the event of a pandemic.
HHS. Interim guidance for cleaning crew for a truck cab when the driver or helper is visibly ill during an influenza pandemic. Mar 23, 2009 [Full text]
Guidelines for cleaning a truck cab after a truck arrives with a driver or helper suspected to have pandemic.
HHS. Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic. Oct 17, 2006 [Full text]
HHS. Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness. May 28, 2008 [Full text]
NCPA (National Citizens' Pandemic Alliance). Get Pandemic Ready: Personal preparedness site, launched Jan 2008 [Web site]
OSHA. Guidance on preparing workplaces for an influenza pandemic. Released Feb 6, 2007 [Full text]
OSHA. How to Protect Yourself in the Workplace during a Pandemic. QuickCard [English full text - PDF] [Spanish full text - PDF]
OSHA. Proposed guidance on workplace stockpiling of respirators and facemasks for pandemic influenza. Released May 13, 2008 [Full text – PDF]
OSHA. What Employers Can Do to Protect Workers from Pandemic Influenza. Fact Sheet [English full text – PDF] [Spanish full text – PDF]
U.S. Army Center for Health Promotion and Preventive Medicine. Non-vaccine recommendations to prevent acute infectious respiratory disease among U.S. Army personnel living in close quarters. May 2007 [Full text - PDF]
WHO. Clinical management of human infection with avian influenza A (H5N1) virus. Aug 15, 2007 [Full text]
WHO. Interim planning considerations for mass gatherings in the context of pandemic (H1N1) 2009 influenza. Released Nov 13, 2009 [full text]
WHO. Interim protocol: rapid operations to contain the initial emergence of pandemic influenza. May 2007 [Full text]
WHO. WHO recommendations relating to travelers coming from and going to countries experiencing outbreaks of highly pathogenic H5N1 avian influenza. Nov 2005 [Full text]
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Social Distancing
Barry JM Pandemic reality check: what can be done - and what can't - to protect against H1N1. (Commentary) Washington Post June 23, 2009 [Full text]
Bootsma CJ, Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in US cities. Proc Natl Acad Sci 2007 (published online Apr 6) [Abstract, with access to free full text]
Brownstein JS, Wolfe CJ, Mandl KD. Empirical evidence for the effect of airline travel on inter-regional influenza spread in the United States. PLoS Med 2006 Oct;3(10) [Full text]
Camitz M, Liljeros F. The effect of travel restrictions on the spread of a moderately contagious disease. BMC Med 2006;4(32) [Abstract]
CDC. Key mental and behavioral health issues related to social distancing for state, local, and tribal health departments and community based organizations. May 5, 2009 [Full text]
CDC. Parental attitudes and experiences during school dismissals related to 2009 influenza A (H1N1) – United States, 2009. MMWR 2010 Sep 10;59(35):1131-4 [Full text]
CDC. Social distancing law assessment template. 2008 [Full text]
Cowling BJ, LLH, Wu P, et al. Entry screening to delay local transmission of 2009 pandemic influenza A (H1N1). BMC Infect Dis 2010 Mar 30;10:82 [Abstract]
France AM, Jackson M, Schrag S, et al. Household transmission of 2009 influenza A (H1N1) virus after a school-based outbreak in New York City, April-May 2009. J Infect Dis 2010 (published online Feb 25) [Abstract]
Glass K, Barnes B. How much would closing schools reduce transmission during an influenza pandemic? Epidemiology 2007 Sep;18(5):623-8 [Abstract]
Glass RJ, Glass LM, Beyeler WE. Targeted social distancing design for pandemic influenza. Emerg Infect Dis 2006 Nov;12(11) [Full text]
Grais RF, Ellis JH, Glass GE. Assessing the impact of airline travel on the geographic spread of pandemic influenza. Eur J Epidemiol 2003;18(11):1065-72 [Abstract]
Haber MJ, Shay DK, Davis XM, et al. Effectiveness of interventions to reduce contact rates during a simulated influenza pandemic. Emerg Infect Dis 2007 Apr 13(4) (published online Mar 2) [Full text]
Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci 2007 (published online Apr 6) [Abstract, with access to free full text]
Hien TT, Boni MF, Bryant JE, et al. Early pandemic influenza (2009 H1N1) in Ho Chi Minh City, Vietnam: a clinical virological and epidemiological analysis. PLoS Med 2010 May 18;7(5):e1000277 [Full text]
Kahn LH. Pandemic influenza school closure policies. (Letter) Emerg Infect Dis 2007 Feb;13(2) [Full text]
Lynfield R. Lessons from Queens. Editorial commentary Journal of Infectious Diseases 2010;201:973-975 [Full text]
Lau JTF, Griffiths S, Choi KC, et al. Widespread public misconception in the early phase of the H1N1 influenza epidemic. J Infect 2009 (published online Jun 17) [Abstract]
Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA 2007 Aug 8;298(6):644-54 [Abstract]
Middaugh JP. Pandemic influenza preparedness and community resiliency. (Commentary) JAMA 2008 Feb 6;299(5):566-8 [Extract]
Miller JC, Danon L, O'Hagan JJ, et al. Student behavior during a school closure caused by pandemic influenza A/H1N1. PLoS ONE 2010 May 5;5(5):e10425 [Full text]
Public Health and Law Enforcement Emergency Preparedness Workgroup. Coordinated implementation of community response measures (including social distancing) to control the spread of pandemic respiratory disease: a guide for developing a memorandum of understanding (MOU) for public health, law enforcement, corrections, and the judiciary. Jul 2008 [Full text - PDF]
Public Welfare Foundation. Paid sick days: attitudes and experiences. Report prepared by the National Opinion Research Center at the University of Chicago. June 2010 [Full text – PDF]
Sadique MZ, Adams EJ, Edmunds WJ. Estimating the costs of school closure for mitigating an influenza pandemic. BMC Public Health 2008 Apr 24;8:135 [Abstract]
Sadique MZ, Edmunds WJ, Smith RD, et al. Precautionary behavior in response to perceived threat of pandemic influenza. Emerg Infect Dis 2007 Sep (published online Jul 20) [Full text]
Sypsa V, Hatzakis A. School closure is currently the main strategy to mitigate influenza A(H1N1)v: a modeling study. (Rapid communications) Eurosurveill 2009 Jun 18;14(24):pii=19240 [Full text]
WHO. Interim planning considerations for mass gatherings in the context of pandemic (H1N1) 2009 influenza. Released Nov 13, 2009 [full text]
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Personal Protective Equipment (PPE)
Bensimon CM, Upshur REG. Evidence and effectiveness in decision making for quarantine. Am J Public Health 2007 (published online Apr 5) [Abstract]
Casanova L, Alfano-Sobsey E, Rutala WA, et al. Virus transfer from personal protective equipment to healthcare employees' skin and clothing. Emerg Infect Dis 2008 Aug (published online Jun 24) [Full text]
CDC/HICPAC. 2007 Guideline for isolation precautions: preventing transmissions of infectious agents in healthcare settings [Web page]
CDC. Interim recommendations for facemask and respirator use to reduce novel influenza A (H1N1) virus transmission. Sep 24, 2009 [Full text]
CDC. Caring for someone sick at home. Dec 5, 2009 [Full text]
CDC. Respiratory hygiene/cough etiquette in healthcare settings [Web page]
Cowling BJ, Chan KH, Fang VJ, et al. Facemasks and hand hygiene to prevent influenza transmission in households. Ann Intern Med 2009 Oct 6 (published online Aug 4) [Full text]
Cummings KJ, Cox-Ganser J, Riggs MA, et al. Respirator donning in post-hurricane New Orleans. Emerg Infect Dis 2007 May;13(5) (published online Mar 30) [Full text]
FDA. FDA clears first respirators for use in public health medical emergencies. May 8, 2007, news release [Full text]
HHS. Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic. Oct 17, 2006 [Full text]
IOM (Institute of Medicine). Preventing transmission of pandemic influenza and other viral respiratory diseases: personal protective equipment for healthcare personnel update 2010. Jan 27, 2011 [Full text]
IOM. Respiratory protection for healthcare workers in the workplace against novel H1N1 influenza A. Sep 3, 2009 [Full text]
IOM. Reusability of facemasks during an influenza pandemic: facing the flu (2006). Prepublication copy [Full text]
IOM. Preparing for an influenza pandemic: personal protective equipment for healthcare workers. Sep 18, 2007 [Full text - prepublication proof]
Lynfield R. Lessons from Queens. Editorial commentary Journal of Infectious Diseases 2010;201:973-975 [Full text]
Lee MC, Takaya S, Long R, et al. Respirator-fit testing: does it ensure the protection of healthcare workers against respirable particles carrying pathogens? Infect Control Hosp Epidemiol 2008 (published online Nov 3) [Abstract]
Morgan O, Kuhne M, Nair P, et al. Personal protective equipment and risk for avian influenza (H7N3). Emerg Infect Dis 2009 Jan;15(1):59-62 [Full text]
OSHA. Respiratory Infection Control: Respirators Versus Surgical Masks. Fact Sheet [English full text – PDF] [Spanish full text – PDF]
OSHA. Respiratory Protection. QuickCard [English full text – PDF] [Spanish full text – PDF]
NIOSH. (National Institute for Occupational Safety and Health) How to properly put on and take off a disposable respirator. February 2010.(In Spanish and English) [Web site]
Phin NF, Rylands AJ, Allan J, et al. Personal protective equipment in an influenza pandemic: a UK simulation exercise. J Hosp Infect 2008 (published online Nov 17) [Abstract]
Roberge RJ. Effect of surgical masks worn concurrently over N95 filtering facepiece respirators: extended service life versus increased user burden. J Public Health Manage Pract 2008 Mar/Apr;14(2):E-19-26 [Abstract]
Shine KI, Rogers B, Goldfrank LR. Novel H1N1 influenza and respiratory protection for health care workers. (Perspective) N Engl J Med 2009 (published online Sep 30) [Full text
Skowronski DM, Li Y, Tweed SA, et al. Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada. CMAJ 2007 Jan 2;176(1):47-53 [Full text]
van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS ONE 2008 Jul 8;3(7):e2618 [Full text]
Viscusi DJ, Bergman M, Sinkule E, et al. Evaluation of the filtration performance of 21 N95 filtering face piece respirators after prolonged storage. Am J Infect Control 2009 (published online Feb 2) [Abstract]
Weiss MM, Weiss PD, Weiss DE, et al. Disrupting the transmission of influenza A: face masks and ultraviolet light as control measures. Am J Public Health 2007 (published online Apr 5) [Abstract]
WHO. How to put on and take off personal protective equipment (PPE). 2008 [Full text]
WHO. How to perform a particulate respirator seal check. Poster. 2008 [Full text]
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