{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:16:19Z","timestamp":1784823379417,"version":"3.55.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Toxicol Ind Health"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>This article discusses several lessons learned in dealing with the interpretation of the Occupational Health and Safety Administration (OSHA) Voluntary Use provision of the Respiratory Health Standard at health-care facilities during the COVID-19 pandemic in the United States. This includes (but is not limited to) (a) confusion about OSHA policy and procedures when health-care workers brought outside personal protective equipment (PPE; N95 filtering facepiece respirators) into the workplace; (b) challenges in adhering to guidelines stated in Appendix D of the Respiratory Protection Standard; (c) difficulty in achieving respirator fit testing for workers; and (d) vague or inconsistent determination of \u201cnon-hazardous\u201d environments (concerning COVID-laden droplets and aerosols). The purpose was to identify gaps in knowledge to help policy makers, enforcement personnel, safety managers, and health-care workers in the United States prepare for similar future events involving PPE shortages.<\/jats:p>","DOI":"10.1177\/0748233720967530","type":"journal-article","created":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T05:15:49Z","timestamp":1606367749000},"page":"681-688","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["OSHA Voluntary Respirator Use: Challenges incurred with use of N95 filtering facepiece respirators during the COVID-19 pandemic"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7429-7503","authenticated-orcid":false,"given":"Jenna L","family":"Gibbs","sequence":"first","affiliation":[{"name":"Gibbs Ventures Consulting, Iowa City, IA, USA"},{"name":"Ag Health and Safety Alliance\u2122, Greenville, IA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W","family":"Nonnenmann","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,11,26]]},"reference":[{"key":"bibr1-0748233720967530","unstructured":"Allen M (2020) A nurse\u2019s hospital wouldn\u2019t let her wear an N95 mask. She hasn\u2019t been to work in weeks. ProPublica, 18 April. Available at: https:\/\/www.propublica.org\/article\/a-nurses-hospital-wouldnt-let-her-wear-an-n95-mask-she-hasnt-been-back-to-work-in-weeks (accessed 7 June 2020)."},{"key":"bibr2-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12745"},{"key":"bibr3-0748233720967530","unstructured":"City News Service (2020) Ten providence nurses suspended over demand for N95 masks while caring for coronavirus patients. Los Angeles Daily News, ABC News, 16 April. Available at: https:\/\/www.dailynews.com\/2020\/04\/16\/10-providence-nurses-suspended-over-demand-for-n95-masks-while-caring-for-coronavirus-patients\/ (accessed 7 June 2020)."},{"key":"bibr4-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2004.10.013"},{"key":"bibr5-0748233720967530","author":"Fadel L","year":"2020","journal-title":"NPR News"},{"key":"bibr6-0748233720967530","unstructured":"Greenhalgh T, Chan XH, Khunti K, et al. (2020) What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? Centre for Evidence-Based Medicine Research. Available at: https:\/\/shieldnhs.org\/wp-content\/uploads\/2020\/04\/COVID-CAT-PPE-MASKS-7.pdf (accessed 7 June 2020)."},{"key":"bibr7-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.109819"},{"key":"bibr8-0748233720967530","unstructured":"Jewitt C, Baily M (2020) Healthcare workers filed more than 4,000 complaints about protective gear. Some still died. 30 June. Available at: https:\/\/www.theguardian.com\/us-news\/2020\/jun\/30\/healthcare-workers-ppe-osha (accessed 7 June 2020)."},{"key":"bibr9-0748233720967530","unstructured":"Khimm S (2020) The forgotten front line: Nursing home workers say they face retaliation for reporting COVID-19 risks. NBC News, 19 May. Available at: https:\/\/www.nbcnews.com\/news\/us-news\/forgotten-front-line-nursing-home-workers-say-they-face-retaliation-n1209606 (accessed 7 June 2020)."},{"key":"bibr10-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2011.0537"},{"key":"bibr11-0748233720967530","unstructured":"Los Angeles Times Editorial Staff (2020) As others see it: Protect health care whistleblowers so they can protect us (editorial). Los Angeles Times, 18 May. Available at: https:\/\/www.latimes.com\/opinion\/story\/2020-05-14\/healthcare-whistleblowers-protection (accessed 7 June 2020)."},{"key":"bibr12-0748233720967530","author":"Luthra S","year":"2020","journal-title":"The Guardian"},{"key":"bibr13-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h694"},{"key":"bibr14-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-2659.2011.00198.x"},{"key":"bibr15-0748233720967530","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201207-1164OC"},{"key":"bibr16-0748233720967530","unstructured":"National Institute for Occupational Safety and Health (NIOSH) (2016a) Certified Equipment List. Available at: https:\/\/www.cdc.gov\/niosh\/npptl\/topics\/respirators\/cel\/default.html (accessed 3 June 2020)."},{"key":"bibr17-0748233720967530","unstructured":"National Institute for Occupational Safety and Health (NIOSH) (2016b) National Personal Protective Technology Laboratory (NPPTL) searchable database. Available at: https:\/\/wwwn.cdc.gov\/niosh-cel\/ (accessed 3 June 2020)."},{"key":"bibr18-0748233720967530","unstructured":"National Institute for Occupational Safety and Health (NIOSH) (2018) Health and safety practices of healthcare workers: Use of respirators and surgical masks for protection against healthcare hazards. Available at: https:\/\/www.cdc.gov\/niosh\/topics\/healthcarehsps\/respiratory.html (accessed 22 July 2020)."},{"key":"bibr19-0748233720967530","unstructured":"National Nurses United (NNU) (2020) NNU COVID-19 survey results. Available at: https:\/\/act.nationalnursesunited.org\/page\/-\/files\/graphics\/0320_NNU_COVID-19_SurveyResults_Updated_031920.pdf (accessed 5 June 2020)."},{"key":"bibr20-0748233720967530","unstructured":"Nylander C (2020) Rosewood Healthcare CNA fired, cites concerns of training and PPE. ABC News, 19 May. Available at: https:\/\/weartv.com\/news\/local\/rosewood-healthcare-cna-fired-cites-concerns-of-training-and-ppe (accessed 7 June 2020)."},{"key":"bibr21-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2009) Assigned protection factors for the revised Respiratory Protection Standard OSHA 3352-02. Available at: https:\/\/www.osha.gov\/Publications\/3352-APF-respirators.pdf (accessed 7 July 2020)."},{"key":"bibr22-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2010) Standard interpretation memo\u2014Definition of a single use and negative pressure respirator. Available at: https:\/\/www.osha.gov\/laws-regs\/standardinterpretations\/2010-01-29 (accessed 7 July 2020)."},{"key":"bibr23-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2018) Enforcement memo\u2014Filtering facepiece respirators and medical evaluations. Available at: https:\/\/www.osha.gov\/laws-regs\/standardinterpretations\/2018-04-24 (accessed 9 June 2020)."},{"key":"bibr24-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2020a) Enforcement memo\u2014Discontinued N95s better than surgical masks. Available at: https:\/\/www.osha.gov\/memos\/2020-04-03\/enforcement-guidance-respiratory-protection-and-n95-shortage-due-coronavirus (accessed 11 June 2020)."},{"key":"bibr25-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2020b) Enforcement memo\u2014Healthcare respiratory protection annual fit-testing for N95 filtering facepieces during the COVID-19 outbreak. Available at: https:\/\/www.osha.gov\/memos\/2020-03-14\/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit (accessed 9 June 2020)."},{"key":"bibr26-0748233720967530","unstructured":"Occupational Safety and Health Administration (OSHA) (2020c) Guidance on preparing for COVID. Available at: https:\/\/www.osha.gov\/Publications\/OSHA3990.pdf (accessed 10 June 2020)."},{"key":"#cr-split#-bibr27-0748233720967530.1","unstructured":"Occupational Safety and Health Administration (OSHA) 1910.134(c)"},{"key":"#cr-split#-bibr27-0748233720967530.2","unstructured":"(2) 71 FR 50187 (2006) Respiratory Protection Standard."},{"key":"bibr28-0748233720967530","first-page":"54","volume":"26","author":"Rengasamy SA","year":"2009","journal-title":"Journal of International Society for Respiratory Protection"},{"key":"bibr29-0748233720967530","unstructured":"Serrano K (2020) OSHA investigating Jersey Shore University Medical Center over staff safety complaints. Asberry Park Press, 15 May. Available at: https:\/\/www.app.com\/story\/news\/health\/2020\/05\/15\/osha-inspects-jersey-shore-university-medical-center-over-safety\/5202720002\/ (accessed 9 June 2020)."},{"key":"bibr30-0748233720967530","author":"Sherry S","year":"2020","journal-title":"Chicago Tribune"},{"issue":"3","key":"bibr31-0748233720967530","first-page":"384","volume":"57","author":"Sinkule EJ","year":"2013","journal-title":"Annals of Work Exposures and Health"},{"key":"bibr32-0748233720967530","author":"Stockman F","year":"2020","journal-title":"New York Times"},{"key":"bibr33-0748233720967530","unstructured":"US Centers for Disease Control and Prevention (CDC) (2020a) Considerations for release of stockpiled N95s beyond the manufacturer-designated shelf life. Available at: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/release-stockpiled-N95.html (accessed 10 June 2020)."},{"key":"bibr34-0748233720967530","unstructured":"US Centers for Disease Control and Prevention (CDC) (2020b) Guidance on respirator (N95) strategy. Available at: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/ppe-strategy\/index.html (accessed 10 June 2020)."},{"key":"bibr35-0748233720967530","unstructured":"US Centers for Disease Control and Prevention (CDC) (2020c) Infographic surgical masks vs respirators. Available at: https:\/\/www.cdc.gov\/niosh\/npptl\/pdfs\/UnderstandDifferenceInfographic-508.pdf (accessed 7 June 2020)."},{"key":"bibr36-0748233720967530","unstructured":"US Centers for Disease Control and Prevention (CDC) (2020d) Pandemic planning. Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Available at: https:\/\/www.cdc.gov\/niosh\/topics\/hcwcontrols\/recommendedguidanceextuse.html (accessed 10 June 2020)."},{"key":"bibr37-0748233720967530","unstructured":"US Centers for Disease Control and Prevention (CDC) (2020e) Strategies to optimize the supply of PPE and equipment. Available at: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/respirators-strategy\/index.html (accessed 10 June 2020)."},{"key":"bibr38-0748233720967530","unstructured":"Wolfson A (2020) Nurse says she was suspended after refusing to treat coronavirus patients without a mask. USA Today, 7 April. Available at: https:\/\/www.usatoday.com\/story\/news\/health\/2020\/04\/07\/nurse-says-she-punished-refusing-work-without-n-95-mask\/2960519001\/ (accessed 9 June 2020)."},{"key":"bibr39-0748233720967530","unstructured":"World Health Organization (WHO) (2020) Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Available at: https:\/\/www.who.int\/publications-detail\/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125 (accessed 11 June 2020)."}],"container-title":["Toxicology and Industrial Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0748233720967530","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0748233720967530","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0748233720967530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:42:46Z","timestamp":1777668166000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0748233720967530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1177\/0748233720967530"],"URL":"https:\/\/doi.org\/10.1177\/0748233720967530","relation":{},"ISSN":["0748-2337","1477-0393"],"issn-type":[{"value":"0748-2337","type":"print"},{"value":"1477-0393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}