HCW (Health Care Workers) exposed to probable or suspected H7N9 patients should be wearing a fitted N95 respirator, gloves, gown and eye protection.
# 7162
Although no cases of H7N9 have been reported outside of Eastern China, the potential for this virus to migrate to other regions of the world – including into the United States – cannot be dismissed.
For that reason, the CDC held a COCA call today for clinicians where they announced a series of Interim Guidance documents on testing, treatment and infection control.
The COCA call also advised on clinician surveillance for the virus here in the United States, which Scott McPherson has just summarized in his blog:
CDC begins actively looking for H7N9 in the United States
Thursday, April 18, 2013 at 02:42
PM by Scott McPherson
From the contents of the interim guidance, and the tone of the presentation, the CDC isn’t taking this threat lightly. They are basing their – admittedly stringent – recommendations on limited data, and adjustments to this guidance may be released as more is learned.
The big news here, is the specifying of fitted N95 respirators, gowns, gloves, and eye protection as a minimum level of PPEs (personal protective equipment) for all HCWs who may have contact with potential or confirmed H7N9 patients.
Ideally, confirmed or suspected patients should be placed in an Airborne Infection Isolation Room (AIIR). When such facilities are not available, they recommend:
If an AIIR is not available, the patient should be transferred as soon as is feasible to a facility where an AIIR is available. Pending transfer, place a facemask on the patient and isolate him/her in an examination room with the door closed. The patient should not be placed in any room where room exhaust is recirculated without high-efficiency particulate air (HEPA) filtration.
For the details, follow the link below. After which, I’ll be back with a little more.
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Patients with Confirmed, Probable, or Cases Under Investigation of Avian Influenza A(H7N9) Virus Infection
This interim guidance provides recommendations for initial infection control in healthcare settings for confirmed, probable, or cases under investigation of avian influenza A(H7N9) virus infection (update on the latest information on H7N9 is available).
These recommendations will be updated as additional information on H7N9, its transmissibility, epidemiology, available treatment, or vaccine options become available. These interim recommendations are based upon current available information and the following considerations:
- Lack of a safe and effective vaccine
- A suspected high rate of morbidity and mortality among infected patients
- Unknown potential for human to human transmission
- Absence of confirmed or probable H7N9 cases in the United States
Follow the above link to read these guidelines in their entirety. If you are a HCW, or Hospital Administrator, you’ll want to follow ALL THE LINKS on the H7N9 Guidance page and take their counsel seriously.
The CDC also released recommendations for antiviral treatment of suspected or confirmed H7N9 patients, revised case definitions, and promises additional guidance in the days to come.
As long as any cases that pop up outside of China are small in number and outbreaks are quickly contained, the quantity of PPEs and antivirals currently available will probably suffice.
But as we saw in 2009 (see Nurses Protest Lack Of PPE’s), once the virus began spreading widely, shortages of N95s quickly appeared. Luckily, that virus proved to be far less virulent than initially feared.
Our Strategic National Stockpile reportedly contains well over 100 million N95 and surgical masks (see Caught With Our Masks Down), but the demand for PPEs during a serious pandemic would far exceed the supply.
At one time the HHS estimated the nation would need 30 billion masks (27 billion surgical, 5 Billion N95) to deal with a major pandemic (see Time Magazine A New Pandemic Fear: A Shortage of Surgical Masks).
Which means that if (and it’s still an `if’) another severe pandemic virus does emerge, we run the risk of being caught with our masks down again.
