In the event of pandemic influenza, personal protection equipment, including disposable particulate respirators and surgical facemasks, will be one of several public health interventions that make up the first line defense against human-to-human transmission of the virus.  The use of facemasks by individuals in the community as part of respiratory etiquette will be one important strategy for reducing the spread of infection. 

In a pandemic situation, effective vaccines and anti-viral medications may not exist or may not be available in adequate quantities.  In that event, non-pharmacological interventions (e.g., hand hygiene, social distancing, and respiratory hygiene/cough etiquette, including the use of masks by the public) will play an even more critical role in pandemic preventive strategies. 

Surgical masks are recommended for use in healthcare settings for routine patient care.  National Institute for Occupational Safety and Health (NIOSH)-certified N95 particulate respirators are recommended for use during high-risk activities (e.g., aerosol generating procedures) in healthcare settings. 

However, current disposable N95 respirators have a limited effective lifespan.  Given the potential duration of a pandemic, which may constitute several waves of outbreaks, even stepped-up production of surgical masks and N95 respirators will be overwhelmed by the demand, especially if community use of masks is widespread. 

Consequently, the Department of Health and Human Services requested the Institute of Medicine of the National Academies to provide recommendations on two issues:

• measures that can be taken that would permit the reuse of disposable N95 respirators in healthcare settings and 
• the need for reusable masks for the general public. 

The final report, Reusabiity of Facemasks During an Influenza Pandemic: Facing the Flu, was released in April 2006.