The U.S. Centers for Disease Control and Prevention (CDC) today revisited its prior recommendations for the selection and use of personal protective equipment (PPE) to protect workers and the general public from COVID-19 transmission and infection. CDC expanded their prior recommendation that only healthcare workers use face masks to a new recommendation that all workers and all members of the general public consider using face masks to prevent the transmission of COVID-19. The Occupational Safety and Health Administration (OSHA) also published guidance last month with details on compliance issues that arise concerning exposure to COVID-19 in the workplace, and that guidance will likely need to be amended to address proposed changes to CDC’s recommendations regarding the use of respirators and face masks. For the coronavirus outbreak, there are three main types of face masks in use: the N95 filtering facepiece respirators (FFR), surgical masks, and fabric masks.

N95 FFRs

The N95 FFR is a NIOSH-certified face mask regulated by OSHA and designed to protect the wearer from occupational exposure to airborne particles and aerosols. N95 FFRs are made of non-porous material and protective only when securely fitted to a wearer’s face. They are designed to offer protection from large droplets and about 95% of small particles (0.3 microns in size). Individual coronavirus particles are smaller than this. Under normal conditions, N95 FFRs are worn once and disposed, but due to supply shortages they are being reused by the same individual for limited periods (e.g., one week or less) if properly maintained.

Surgical Face Masks

Surgical masks are not certified by NIOSH and are not regulated as respirators by OSHA, but they are approved by the Food and Drug Administration (FDA). Surgical masks are made of porous filtering material, loose fitting, and may protect the wearer against large droplets but do not offer protection against small particles or aerosols. They are disposable and most effective in a single use, but due to supply shortages they are being reused by the same individual for limited periods (e.g., one week or less) if properly maintained.

Fabric (Homemade) Face Masks

Fabric face masks range widely in material and quality, are loose fitting, and are not regulated as respirators by OSHA. They might offer limited protection against large droplets but do not protect against small particles and aerosols. According to one study, fabric face masks were three times less effective than surgical face masks. They are not considered PPE by OSHA or the CDC. CDC only recommends them for use by healthcare workers “as a last resort.”

Non-Voluntary Use of N95 FFRs

If the N95 FFR is being used to address an elevated OSHA airborne contaminant that is known or expected to be at or near the regulatory limit or “permissible exposure level” (PEL), or if the mask is needed to address a “recognized hazard” such as to prevent exposure to COVID-19 in a work setting where the contaminant is known or expected to be present (e.g., in a healthcare setting for workers treating individuals with COVID-19), then the entire OSHA respiratory protection standard is applicable and must be met. See 29 CFR 1910.134. That includes the need for a detailed written respirator program, initial and annual medical evaluations for the wearer, initial and annual fit testing, and initial and annual training, etc.

On March 14, 2020, OSHA published temporary enforcement guidance, which made a relatively minor change to this requirement. Under the new temporary guidance, OSHA is allowed to exercise “enforcement discretion” concerning the annual fit testing requirement referenced above, see 29 CFR § 1910.134(f)(2), in work settings where the face masks are used to prevent exposure to COVID-19 if the employer also does the following:

1)   Makes a good-faith effort to comply with the rest of 29 CFR § 1910.134
2)   Uses only NIOSH-certified respirators
3)   Implements CDC and OSHA strategies for optimizing the supply of N95 FFRs and prioritizing their use
4)   Performs initial fit tests for each employee with the same model, style, and size respirator that the worker will be required to wear for protection against COVID-19

Voluntary Use of N95 FFR 

If the N95 FFR is not being used to address an elevated OSHA airborne contaminant and is not needed to address a “recognized hazard” in the workplace (i.e., it’s being used in a typical workplace where the COVID-19 virus is not known or expected to be present), the use of an N95 FFR is not required and is therefore considered “voluntary.” Voluntary use of the N95 FFR modifies the applicable OSHA requirements for use of the device in the workplace, but it does not eliminate them. For the voluntary use of N95 FFRs, the minimum OSHA requirements that must be addressed are as follows:

• The employer must make available a copy of Appendix D to the 29 CFR 1910.134 (or the equivalent information) for employees that voluntarily use the N95 FFR. See https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppD.
• The N95 FFR must be discarded after use, or when it becomes damaged or soiled. See 29 CFR 1910.134(h)(1).
• According to OSHA, such masks cannot be cleaned or disinfected after use and must be disposed unless the respirator manufacturer provides alternate cleaning procedures in their user instructions that would allow for cleaning and disinfecting of the device. Generally, there are no such procedures for the N95 FFR.
• Employers must provide the N95 FFR to its employees free of charge, and the face masks must be kept clean, sanitary, and in good working order. See 29 CFR 1910.134 (h)(1)(i).
• Because the N95 FFRs cannot be cleaned and disinfected, they may only be used by one user, and, once soiled or contaminated, must be discarded.
• If respirators are reused by the same individual, they must be stored to protect them from contamination, dust, sunlight, extreme temperatures, excessive moisture, chemicals, and damage or deformation of the facepiece or exhalation valve. See 29 CFR 1910.134(h)(2)(i).
• Employers must also ensure the respirators are inspected by the user before each use. Respirators that fail an inspection, or are otherwise found to be defective, must be removed from service. See 29 CFR 1910.134 (h)(3)(i)(A) and (h)(4).

If the N95 respirator type is a rubberized, plastic, or elastomer quarter-face mask with replaceable filtering cartridges (i.e., it is not an N95 FFR), in addition to the requirements specified above, the employer must also prepare a written respiratory protection program, conduct initial medical clearance evaluations for employees wearing the cartridge type respirators, and provide training to the workers on cleaning, maintenance, and storage of the device.  

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