# 3598
In yesterday’s blog (see Masking Our Disappointment) I wrote on the details of the current and proposed PPE (Personal Protective Equipment) recommendations for HCWs (health care workers) in close contact with novel H1N1 patients.
The proposed minimum standard would recommend simple surgical masks, rather than N95 respirators, for HCWs caring for novel H1N1 patients (except when doing aerosolizing procedures).
Next week a panel of experts will meet in an all-day session at the IOM (Institute of Medicine) to discuss health care worker’s needs for protective equipment during this pandemic.
First the information on that meeting, then some additional comments.
IOM Panel Studying Health Workers' H1N1 PPE Needs
By Sept. 1, the 14-member committee will provide a letter report to CDC and OSHA addressing personal protective equipment needs for this crucial workforce.
- Aug 04, 2009
At the request of CDC and OSHA, an ad hoc committee of 14 public health leaders has been assembled by the Institute of Medicine to study health care workers' PPE needs against the novel influenza A (H1N1) virus and issue a letter report to both agencies by Sept. 1, 2009. Seating is already filled for an IOM workshop on this topic Aug. 11-13 at the National Academy of Sciences Building, 2100 C Street NW in Washington, D.C.
The committee's roster includes Trish M. Perl, M.D., MSc, director of hospital epidemiology and infection control and the hospital epidemiologist at the Johns Hopkins Hospital; Peter Palese, Ph.D., chair of the Department of Microbiology at the Mount Sinai School of Medicine in New York, a renowned researcher of the pathogenicity of influenza viruses who was elected to the National Academy of Sciences in 2000; Raina MacIntyre, Ph.D., professor of Infectious Diseases Epidemiology, head of the School of Public Health and Community Medicine at the University of New South Wales, Australia, and leader of the Strategic Priority Infectious Diseases Epidemiology Research Unit of Australia's National Centre for Immunization Research and Surveillance; William H. Kojola, industrial hygienist for the AFL-CIO's Department of Occupational Safety and Health; Howard J. Cohen, Ph.D., professor emeritus of the Occupational Safety and Health Department at the University of New Haven and former editor in chief of the American Industrial Hygiene Association Journal; and M.E. Bonnie Rogers, DrPH, associate professor of nursing and public health and director of the North Carolina Occupational Safety and Health Education and Research Center and the Occupational Health Nursing Program at the University of North Carolina School of Public Health, Chapel Hill, and a past president of the American Association of Occupational Health Nurses.
The workshop has four goals:
- Examine the emerging science and clinical experience base associated with nH1N1
- Discuss criteria used to delineate infection control guidelines
- Discuss criteria used to assess risk to the health care workforce
- Examine what's known about the effectiveness of medical masks, respirators, gowns, gloves, and eye protection in preventing nH1N1 and seasonal influenza transmission
While this meeting has reached its seating capacity and registration is closed, you can still hear the proceedings live on the Internet via a day-long webcast of the meeting.
Event Date:
August 11, 2009 - August 13, 2009
IMPORTANT NOTICE:
We have reached our seating capacity for the workshop and registration is CLOSED.
A live audio webcast of the workshop will be available:
August 12, 2009 - 8am-5pm (Eastern) and Thursday, August 13, 2009 from 8am-12pm (Eastern).
To access the webcast at those times, go to www.nas.edu.
If you have any questions regarding the workshop, please contact Judy Estep at jestep@nas.edu or 202-334-2013.
The IOM meeting will feature an august group of public health officials whom, I suspect, have their collective backs against the wall with this decision.
I don’t envy them the position they are in.
Were they to decide to recommend keeping the CDC’s current guidelines – that all HCWs caring for novel H1N1 patients needed N95 respirators – where would the respirators come from?
Last May the Strategic National Stockpile had roughly 80 million N95 respirators. Or enough to last the roughly 10 million HCWs (who will need a fresh one every 4 hours) and first responders less than a week.
Between that, and what’s in storage (or in the supply pipeline) we may have enough to last a few weeks.
Ten million HCWs would need billions of masks over a 3 or 4 month pandemic wave, not tens (or even hundreds) of millions. Attempts by the HHS and OSHA to convince the private sector to stockpile enough masks for their employees have proven less than successful.
The bottom line is, if the current guidelines were maintained and all HCWs wore N95s when caring for patients, we’d likely run out of the respirators in a matter of weeks. And with the entire world in a pandemic, our ability to resupply is in serious doubt.
One can be thankful, I suppose, that we aren’t facing the deadlier H5N1 virus threat right now, because we’d be in no better position to deal with it than we are with the H1N1 virus.
I’ve no scientific evidence to offer on the relative merits of surgical facemasks versus N95 respirators, beyond that which the CDC and OSHA have published repeatedly over the past few years. The assumption has always been that surgical masks are of dubious value, and that N95s were the preferred level of protection.
While we are promised an `evidence based decision’ on the use of surgical masks one can’t help but believe that the fact that we don’t have enough N95s to even begin to meet our needs will be taken into account.
It is pretty hard to recommend a resource you know we are going to run out of.
Health care workers, who will be on the front lines and face-to-face every day with infectious patients, are likely to have serious questions about any reduction in the recommended level of personal protective equipment during this pandemic.
ACIP and HICPAC and the IOM, along with the CDC and HHS are in a impossible position here.
Even if (and its a big `if’) surgical masks offer a `reasonable level of protection’ against influenza in a health care setting, every HCW who gets infected this fall and winter will believe it was because of inadequate PPEs.
Already I’m hearing from HCWs who say that they won’t work during a pandemic without N95s. Many are concerned not only about their own health and safety, but about taking the virus home to their families, and spreading it to other patients.
Quite honestly, I can’t say that I blame them.
This all has the potential to get quite messy.
A certain number of HCWs who will agree to work with surgical masks (and some won’t) will no doubt find themselves infected this fall and winter with the pandemic virus.
Some, tragically, may even die.
While it may be impossible to prove that the lack of N95s contributed to their illness, the assumption will be that their infection was caused by inadequate PPE.
And that may well influence the decision of their co-workers as to what risks they are willing to continue to take.
Not only will facilities be faced with absenteeism due to illness, a certain number of HCWs (and support staff such as nutritional services, housekeeping, security, and others) may decide not to work under those conditions.
Polls conducted over the past 3 or 4 years indicate that anywhere between 15% and 50% of HCWs might not work during a pandemic - and one of their greatest concerns has always been a lack of PPEs. Here are just a few I’ve covered.
UK Poll: Will HCW’s Work In A Pandemic?
Australia: Will Doctors Work In A Pandemic?
Pandemic Issues For Home Health Providers - Pt 3
Catching Up With The Nurses Poll
The HCW Debate (Update)
Canadian Study: Nurses Left Short In A Crisis
And The New Survey Says . .
Report: Health Care Workers In Peril
I won’t even begin to predict how all of this turns out. I know that the HHS can’t wave a magic wand and make billions of N95 masks suddenly appear. Like it or not, we are going to run short.
Whether HCWs accept that surgical masks offer `reasonable’ levels of protection remains to be seen.
But even more important is how health care workers fare with these masks during this pandemic. If we see high levels of infection among HCWs, or a large number of deaths, the damage inflicted on our entire health care system will be incalculable.
The stakes here, quite frankly, are enormous.
