# 3597
For the past several years the assumption by OSHA, the CDC, and just about everyone in the healthcare profession has been that healthcare workers would need N95 respirators to protect them against a pandemic flu virus.
More than a year ago, OSHA published a recommended stockpiling guideline for Health Care facilities, where they estimated that every nurse with direct patient contact would need roughly 480 N95 respirators for a 12 week pandemic wave.
Admittedly, these recommendations were made with the much deadlier H5N1 virus in mind.
Currently (and updated as recently as 5pm last night, Aug 5th) the CDC’s recommendation is that anyone providing care to a known, probable, or suspected novel H1N1 patient wear an N95 Respirator.
7 “Caring” includes all activities that bring a worker into proximity to a patient with known, probable, or suspected novel H1N1 or ILI, including both providing direct medical care and support activities like delivering a meal tray or cleaning a patient’s room.
These would seem reasonable and prudent precautions, and based on my conversations with a number of nurses and other HCW’s (Health Care Workers), this represents the level of protection that they expect to have when caring for a novel flu patient.
Earlier this week, nurses in California held a protest rally over a lack of adequate PPEs (Personal Protective Equipment) supplied to them when caring for pandemic flu cases.
This is obviously an emotionally charged subject, and memories of the deaths and illnesses of nurses in Canada during the SARS outbreak – which many believe was exacerbated by inadequate PPEs – remain fresh in the minds of many HCWs.
I’ve seen estimates that this fall and winter, the United States could need as many as 5 Billion N95 respirators just for health care workers and first responders. That is an incredible number and far exceeds what we have in our Strategic National Stockpile and in the stock rooms of hospitals around the nation.
Earlier this year the Minnesota Pandemic Ethics Project released estimates and assumptions (see Looking At The Minnesota Pandemic Assumptions) on what items might be in short supply during a pandemic.
They estimated that the state would run out of N95 masks 3 weeks into a pandemic.
There is now a move afoot to lower the recommendation from using the more expensive (and widely assumed to be more protective) N95 respirators to using surgical masks (which are more plentiful) in a healthcare setting.
The same surgical masks we’ve been told for years provided `little or no protection’ against the influenza virus.
This recommendation comes from the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC).
Recommendation of HICPAC Influenza A (H1N1) Working Group
At a public meeting held on July 23, the Centers for Disease Control and Prevention’s (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) unanimously adopted the recommendations of the Influenza A (H1N1) Working Group with regards to “Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting.”
The Working Group recommendations were based on the results of a systematic review on respiratory protection devices for Influenza A (H1N1) performed by the Center for Evidence-Based Practice at the University of Pennsylvania Health System in June 2009.
The guidance development process continues with a CDC meeting to hear the views of labor organizations on July 28. On August 11-14, 2009, the Institute of Medicine (IOM) will convene an expert panel on personal protective equipment for healthcare personnel in the workplace against H1N1.
The guidance development process is expected to be completed by October 1, 2009. APIC is pleased that the Working Group recommendations are consistent with an APIC-endorsed position paper.
As some of you are aware, a number of state health departments, after recognizing that the Novel H1N1 influenza was similar to the seasonal influenza, advised healthcare organizations within their jurisdictions that standard and droplet precautions should be followed for patients with Novel H1N1 rather than airborne infection isolation.
After a systematic review of the transmission of airborne infections, the H1N1 Working Group arrived at the following recommendations for minimum isolation precautions:
• Healthcare personnel should wear a surgical mask when caring for patients with suspected or confirmed cases.
• An N95 respirator is recommended for select procedures that are potentially aerosol-generating (e.g. bronchoscopy, intubation, CPR, open airway suctioning, and sputum induction).
• Healthcare personnel should adhere to standard and droplet precautions for 7 days after the onset of illness or until symptoms resolve, whichever is longer.
Healthcare facilities are advised to regularly perform risk assessments that consider the current activity of H1N1 in the community and related issues.
July 23, 2009
My guess is that this recommendation – if adopted – is not going to be well received by many HCWs who have been told (for years) that surgical masks offer little or no protection against influenza viruses.
Is there an alternative?
Probably not. Not at this late date, anyway. The time to have stockpiled N95s was a year or more ago when OSHA and the HHS were both advising facilities to do so.
Disappointingly, many facilities apparently decided they had other priorities. And now that window of opportunity is either closed, or nearly so.
The question now is whether surgical masks are actually going to be `good enough’ to protect healthcare workers (and by extension their families and their patients), and whether HCWs are going to be willing to work with what they are likely to perceive as a reduced level of protection.
And I don’t think we know the answer to either of those questions right now. For the sake of HCWs, their families, and their patients, I hope APIC is right.
The bad news is, we are about to find out.
