# 5265
Regular readers will no doubt recall the controversy that surrounded the substitution of surgical masks for N95 respirators for some HCWs dealing with the 2009 H1N1 pandemic.
Nurses Protest Lack Of PPE’s
Report: Nurses File Complaint Over Lack Of PPE
California Nurses Association Statement On Lack Of PPE
For decades, the assumption was that only properly fitted N95 masks protected the wearer, and that surgical masks were only worn by HCWs to protect the patient during invasive procedures.
N-95 Respirator Surgical Facemask
But over the past two years we’ve seen dueling studies that alternately show surgical masks to be an effective barrier against respiratory viruses . . . or pretty much useless.
Take your pick.
In October of 2009 the NEJM published a perspective article (see NEJM Perspective: Respiratory Protection For HCWs) based on a 2009 IOM evaluation of surgical masks vs. respirators, and came out in favor of the N95.
A few days later JAMA (Journal of the American Medical Association) published a study which reported that HCWs using surgical masks experienced `noninferior rates of laboratory-confirmed influenza’.
In March of 2010, we saw the following study (see Study: Efficacy of Facemasks Vs. Respirators) in Clinical Infectious Diseases, that suggested that surgical masks are just as effective as respirators in protecting HCWs.
In guidance, updated as late as March of 2010, the CDC continued to recommend N95 respirators for HCWs who came in close contact with suspected or confirmed influenza patients.
But in June of last year, the CDC proposed new guidance that relaxed those recommendations to using surgical masks for routine care, and reserving N95 masks for aerosol producing procedures (intubation, suctioning, etc).
Still, the controversy remains.
Adding to the confusion, we’ve seen recent studies that give more credence to the notion that influenza may be spread in aerosolized form (see Study: Aerosolized Transmission Of Influenza), as opposed to primarily by large droplets.
But the truth is, our knowledge of how influenza spreads, and what barriers work to protect HCWs, is severely limited.
I’ve mentioned the National Academies Press a number of times before as a terrific source for scientific reports, and books that may be purchased, viewed online - or in many cases - downloaded for free.
If you have a scientific bent at all, you owe it to yourself to visit http://www.nap.edu/ to peruse the more than 3,000 titles available.
The IOM (Institute of Medicine) has just released, through the National Academies Press, an extensive, 200+ page update on the use of PPEs (personal protective equipment) for healthcare workers when facing pandemic influenza and other viral respiratory illnesses.
The short version is, we need better science upon which to make decisions regarding the right kind of protection for HCWs.
While the entire 200 page pre-publication pdf can be downloaded for free, you can also view an executive summary and an abbreviated list of recommendations.
Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel Update 2010
- Released: January 27, 2011
- Type: Consensus Report
In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus, as well as questions regarding personal protective equipment (PPE) for healthcare personnel. Researchers still have much to learn about how influenza is transmitted from person to person, and one major question that arose during the H1N1 influenza pandemic was determining what types of PPE—particularly face masks or respirators—are needed to protect healthcare personnel from disease transmission. Because the focus of research efforts often shifts to other health concerns between pandemics, continuing the research momentum is critical to ensure that the nation is prepared for the next influenza pandemic.
In light of the unanswered research questions following the 2009 H1N1 influenza pandemic, the National Personal Protective Technology Laboratory at the National Institute for Occupational Safety and Health (NIOSH) asked the IOM to assess the progress of PPE research and to identify future directions for PPE for healthcare personnel. While the IOM finds that there are gaps and deficiencies in the research about PPE use in health care, there is sufficient knowledge to recommend a four-pronged strategy for effective PPE use:
- Deliberate planning and preparation at the leadership and organizational levels
- Comprehensive training for all personnel, including supervisors and managers
- Widespread and convenient availability of appropriate PPE devices
- Accountability at all levels of the organization
The IOM also offers several recommendations for continuing the momentum of PPE research that are detailed in the report and the report brief. The more scientists and researchers know about how to maximize the effectiveness of PPE and its use, the more prepared we will be for the next influenza pandemic.
Report at a Glance
Recommendations (HTML)
