Respiratory Protection Outside the Workplace
Protecting Those Without Respiratory Protection Programs from Inhalation Hazards
BY RAYNA S. FALAVOLITO AND SHAWN G. GIBBS
Participating in a respiratory protection program (RPP) remains the gold standard to reduce exposures for an individual who must wear respiratory protection due to workplace inhalation hazards that cannot be addressed through other controls. Industrial hygienists and occupational and environmental health and safety professionals are familiar with the purpose, benefits, and limitations of RPPs and understand that a well operated program is the best way to reduce exposure and maintain the respiratory health of workers. However, the main drawback to an RPP for most of the population is that one is simply not available to them. In 2018, NIOSH reported that 1.3 million workplaces require workers to wear respiratory protection, which leaves the remainder of the population without a reliable source for guidance on respiratory protection when they encounter respiratory hazards.
IHs and OEHS professionals have long known that the general population and workers without RPPs use respiratory protective equipment (RPE), likely incorrectly, which means that users are not receiving the maximum level of protection. After the events of the COVID-19 pandemic, this can no longer be ignored. The entire population has been exposed to the terms “filtering facepiece respirator” (FFR) and “N95,” and many other terms related to respiratory protection are now part of the common vernacular. But familiarity with these terms or the equipment does not mean that the population knows the basic principles of RPE, how to use it effectively, when to use it, its limitations, and other aspects that are normally covered within an RPP. IHs and OEHS professionals now routinely encounter workers who are wearing RPE in the workplace, not because of the occupational environment but because of perceived or actual respiratory hazards from the general environment. These hazards might include particulate matter from wildfires, viral community spread, and pollution. In some cases, workers may self-identify as immunosuppressed or immunocompromised and wish to have an additional layer of protection. Workers are also now more likely to utilize RPE in their lives outside the workplace.
A report published in 2022 by the National Academies of Sciences, Engineering, and Medicine’s Committee on Respiratory Protection for the Public and Workers Without Respiratory Protection Programs at their Workplaces addresses these issues. The report, which is freely available from the National Academies website, can assist IHs and OEHS professionals in efforts to meet the respiratory protection needs of the public and workers without RPPs. Information in this article stems from this report.
RESPIRATORY PROTECTION OUTSIDE AN RPP
In the workplace, RPPs are intended to ensure that individuals wear RPE correctly, maintain the equipment, and understand the limitations. However, proper use of RPE outside an RPP can also be effective at reducing exposures from environmental, biological, and other respiratory contaminants that workers and community members are exposed to in their personal and work lives.
Although approximately 1.3 million workplaces have RPPs, there are many instances in which workers prefer to wear RPE, falling into the category of voluntary protection. Voluntary RPPs have many nuances, and the requirements are not always explicit. Workers have the right to wear RPE during tasks for which the employer or OSHA standard does not require respirator use. But when a worker voluntarily wears RPE, the employer is required to determine if the RPE presents a new hazard to the worker, if the worker is medically fit to wear the RPE of their choice, and to educate the worker on the contents of Appendix D of OSHA’s respiratory protection standard, which outlines information for employees who use respirators when not required under the agency’s standard. These requirements can be burdensome for workplaces without an RPP or a dedicated IH or OEHS professional, which results in some employers discouraging workers from voluntary RPE usage or not satisfying the requirements, creating additional safety challenges.
Beyond workplaces without an RPP, emergency situations may drive emergency responders and community members to wear RPE to protect themselves from unknown hazards. For example, in areas where wildfires and other natural disasters are common, it is important for members of the community to have access to RPE that will protect them from hazards during such emergencies. Guidelines published by organizations like NIOSH, CDC, and EPA are available to assist the public in determining when and what RPE to don. A fact sheet published by NIOSH provides information about how to properly use RPE as part of a personal or family emergency response plan.
Socioeconomically vulnerable populations may be at a disadvantage when recovering from environmental or health-related challenges. These populations are also more likely to reside in areas with environmental pollution. Under these circumstances, individuals who are facing illness, living in areas with poor air quality, or suffering the effects of a natural disaster may feel the need to wear RPE to keep themselves and their families safe but not have the financial ability to acquire or purchase RPE, or access education resources on how to utilize it properly.
Another group who may don RPE outside of a formal RPP are individuals who are immunocompromised or immunosuppressed. Whether they are advised to wear RPE by their physician or opt to wear it voluntarily, it is of utmost importance that these individuals wear the right RPE properly to protect themselves from inhaling physical, chemical, and biological hazards. Along with the immunosuppressed, the public has become increasingly aware of times in which RPE can help prevent hazardous exposures or illnesses. For example, individuals may wear an N95 when their potential for contracting a virus like influenza is increased, such as during cold and flu season or when they are in places like hospitals.
The public’s partial understanding of RPE’s role in protection from all different types of hazards can be leveraged to enhance education and awareness, and better protect individuals from the increasing respiratory hazards of today’s world. IHs and OEHS professionals play a crucial role in helping communities understand when, where, and how RPE is used in daily life and motivations for wearing RPE. Practitioners in IH and OEHS can also help “bridge the gap” so that RPE can be effectively used to protect individuals beyond workplace RPPs.
IHs and OEHS professionals play a crucial role in helping communities understand when, where, and how RPE is used in daily life and motivations for wearing it.
NUMEROUS CHALLENGES
Encouraging RPE access and usage among the public presents a variety of challenges. The COVID-19 pandemic introduced many individuals to RPE, and they are now familiar with how they think they should utilize RPE. This feeling of familiarity, coupled with limited training on proper usage and limitations plus emergency usage protocols, instilled the “bad habits” that we all observed during the early days of the COVID-19 pandemic and that we still observe today. These bad habits include limited or no monitoring of health, fit testing, or re-fit testing; extended use and improper storage between wears; and no means for wearer training or retraining—essentially, none of what is provided in a successful RPP.
The need to retrain a U.S. public that has not been utilizing RPE correctly is exacerbated by the instructions provided by many manufacturers with their RPE. Often, these instructions are overly complex, written for IHs and OEHS professionals without keeping the standard American literacy level in mind, or direct the user to consult their RPP, which for many does not exist. The instructions also often appear either on the box or as a single instruction sheet within a box, which almost ensures the instructions will be separated from the RPE—a problem that could be corrected with a QR code on the RPE itself, simplified written instructions with each RPE, or other options.
The decision to wear RPE in public has been increasingly politicized nationally and, in some cases, criminalized, as explained in a Forbes article about how some U.S. jurisdictions are moving to ban face coverings in certain settings. By extension, changes in social norms stemming from the politicization of RPE usage during the COVID-19 pandemic may make some users less compliant with their workplace RPP programs. Prior to the pandemic, some states and localities had bans or laws against the wearing of a mask or face covering in public in an effort to increase public safety. Recent efforts to ban or criminalize the public usage of RPE have ramifications beyond politics and public safety. For instance, immunocompromised or immunosuppressed individuals in areas where public RPE usage is criminalized are more vulnerable. Such bans or laws also limit conscientious individuals who may be ill but are still required to work with the public. National security may be negatively impacted over the long term if these changes complicate response associated with RPE used for chemical, biological, radiological, and nuclear attacks, or emergency response to wildfires, industrial accidents, and other events.
PUBLIC EDUCATION AND AWARENESS
Clear gaps in the previous public health campaign on respiratory protection deployed during the COVID-19 pandemic show a need to reevaluate communication strategies and the role of IHs, OEHS professionals, and public health professionals in engaging with the public on this issue. Practitioners in these professions can help explore ways to reach large audiences with education about respiratory protection, provide RPE when necessary, and even influence policy to make education or training and RPE more accessible.
IHs and OEHS professionals should understand the nuances and the scope of respiratory protection outside of RPPs, including the many places and situations in which workers may use RPE in their personal lives, from painting or sanding at home to increasing protection from viruses and bacterial infections. As described in the National Academies report, it is important to develop communities that understand the benefits and limitations of using RPE to protect the respiratory system from everyday inhalation hazards. One way to do this would be to develop a public health campaign that addresses the flaws in previous community outreach and education techniques on the topic of respiratory protection that were prevalent during the COVID-19 pandemic. For example, a new public health campaign on respiratory protection must be accessible to the general public, and statistics from the National Literacy Institute suggest that communications should be at a 5th grade reading and writing level. The campaign should also be designed in a way that does not scare the public into avoiding RPE altogether. While it’s important to convey the limitations of RPE, communications should not dwell on “do not use here…” or “do not use when...” statements, as these could leave RPE users second-guessing its effectiveness. A campaign such as this could use social media as a wide-reaching, low-cost, and effective means to communicate information about RPE with broad audiences in a new, “trendier” way.
IHs and OEHS professionals should understand the many places and situations in which workers may use RPE in their personal lives, from painting or sanding at home to increasing protection from viruses and bacterial infections.
While many individuals may have lost trust in RPE or those promoting its use following the COVID-19 pandemic, encouraging general use of RPE can help change habits among the public. IHs and OEHS professionals—who are likely already familiar with communicating this type of information to various audiences—can help the public understand the short-term benefits of wearing RPE in different circumstances, whether it be to not get sick while visiting a hospital or to avoid acute symptoms of solvent exposure when stripping paint at home. Convenient access to the correct RPE for the hazards present is another important consideration; this could look like having FFR set by the door of a medical facility or the correct RPE cartridges placed next to solvents sold in hardware stores.
Beyond a public health campaign, IHs, OEHS professionals, and public health professionals can work with and encourage RPE manufacturers to publish information about the uses, effectiveness, and limitations of their specific RPE. For instance, the packaging for half-face respirators available at hardware stores should include clear, concise details about different filters and the uses of cartridges. These details should also be printed on FFR boxes that the public commonly encounters.
Other areas where IHs, OEHS professionals, and others can help increase awareness on the variety of uses of RPE and its benefits include in schools or via their local Red Cross chapter, where emergency preparedness is discussed and RPE may be provided as part of an emergency preparedness kit. Additional efforts might include partnering with workplaces that have established RPPs to implement wider training to staff and their families about RPE, proper use, storage, maintenance, and limitations. Using air quality alerts as real-life data may help IHs and OEHS professionals demonstrate the benefits of RPE and encourage confidence in its use.
CALL TO ACTION
RPPs, while not perfect, are currently the best way to provide respiratory protection and reduce exposures to workers. IHs and OEHS professionals can support existing RPPs, including by urging innovation and novel approaches to improve both RPPs and RPE, while advocating for the programs’ expansion to cover additional worker populations. But those in the IH and OEHS professions must accept that many workers and the public face respiratory hazards both inside and outside of the workplace and are wearing RPE outside of an RPP. This acceptance will not undercut support for RPPs, and it’s possible to help those outside of RPPs while fully embracing the RPP, RPP expansion within the workplace, and improvements for RPPs. IHs’ and OEHS professionals’ training and education sometimes leads professionals to discourage RPE usage outside of an RPP, even when it may be beneficial, allowing “perfect to be the enemy of the good.”
We suggest shifting from a mantra of “RPE only in an RPP” to “RPE works best in an RPP but can also reduce exposures in other situations.” Remember, not all individuals have access to IHs or OEHS professionals, so together we can work with organizations to help develop education and materials for individuals, organizations, and communities to improve understanding of the need for RPE, how to select RPE, its limitations, and more. We can work toward providing better respiratory protection to all members of our society by engaging the public and organizations that protect the public and by advocating for the distribution of information on RPE that is easily consumable by the general public outside of an RPP. Workers and the public face growing respiratory protection needs, and adapting to help meet these needs does not mean abandoning the RPP or our IH and OEHS principles—it’s accepting the challenges of today’s reality.
RAYNA S. FALAVOLITO is set to complete her Master of Public Health with a concentration in occupational health and safety from the Department of Environmental and Occupational Health at Texas A&M University School of Public Health in May 2025.
SHAWN G. GIBBS, PhD, MBA, CIH, is a professor of environmental and occupational health and dean at Texas A&M University School of Public Health.
Acknowledgements: The authors acknowledge the National Academies of Sciences, Engineering, and Medicine for their role in exploring this subject, especially the members of the National Academies’ Committee on Respiratory Protection for the Public and Workers Without Respiratory Protection Programs at their Workplaces (which included Shawn G. Gibbs) who produced the consensus study report titled “Frameworks for Protecting Workers and the Public from Inhalation Hazards.” The au
thors also acknowledge the National Institute of Environmental Health Sciences Worker Training Program, which highlighted the need to explore this subject in the Synergist article “Leveraging External Training Resources.” Finally, the authors thank Aurora Le for her work and insights on this subject and her editorial support of this article.
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RESOURCES
Forbes: “From Mask Mandates to Bans: Some Jurisdictions in U.S. Are Doing a 180” (July 2024).
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National Academies of Sciences, Engineering, and Medicine: “Frameworks for Protecting Workers and the Public from Inhalation Hazards” (2022).
National Literacy Institute: “Literacy Statistics 2022-2023” (2024).
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OSHA: Occupational Safety and Health Standards, Personal Protective Equipment, Respiratory Protection.
The Synergist: “Leveraging External Training Resources” (September 2024).