N-95 Respirator Surgical Facemask
# 7197
Yesterday the Public Health Agency Of Canada published a set of Interim Guidance - Avian Influenza A(H7N9) Virus documents dealing with infection prevention and control in acute care settings.
Compared to the guidance released last week by the United States (see CDC Interim H7N9 Infection Control Guidelines), the Canadian version is far less stringent.
The CDC Interim H7N9 Infection Control Guidelines, call for 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.
Additionally, confirmed or suspected patients are to be placed in an Airborne Infection Isolation Room (AIIR) whenever possible.
Below you’ll find excerpts that illustrate some of the differences:
Infection Prevention and Control Guidance for Acute Care Settings
Notes
- Footnote a
- Acute care - A facility/setting where a variety of inpatient services is provided, which may include surgery and intensive care. For the purpose of this document, acute care also includes ambulatory care settings such as hospital emergency departments, and free-standing ambulatory (day) surgery or other day procedures (e.g., endoscopy) centres.
- Footnote b
- IPC measures included in this interim guidance are considered the minimum recommendations; a point-of-care risk assessment approach (Appendix A) should be used by the HCW prior to every patient interaction, to determine what level of respiratory, and other personal protection, supports the use of additional measures where indicated.
- Footnote c
- Patient's room, cubicle or designated bedspace.
- Footnote d
- Surgical or procedure masks.
- Footnote e
- Historically, H7 influenza A viruses have shown a marked ocular tropism and have been associated with conjunctivitis in humans, with occasional cases leading to more severe illness. The importance of use of eye protection/face shields/visors should be reinforced as part of IPC precautions for this virus.
- Footnote f
- Whenever possible AGMPs should be performed in an airborne infection isolation room.
PATIENT PLACEMENT AND ACCOMMODATION
Patients suspected or confirmed to have H7N9 infection should be cared for in single rooms, if possible, with designated private toilets and patient sinks. If cohorting is necessary, only patients who are confirmed to have H7N9 infection should be cohorted together. Infection prevention and control signage should be placed at the room entrance indicating contact and droplet precautions required upon entry to the room. Airborne infection isolation rooms should be used for aerosol-generating medical procedures whenever possible.
<SNIP>
PERSONAL PROTECTIVE EQUIPMENT
Personal protective equipment (PPE) for contact and droplet precautions should be provided outside the room of the patient suspected or confirmed to have H7N9 infection. HCWs, families and visitors should use the following PPE:
Gloves
Gloves should be worn upon entering the patient’s room (for care of the patient and for contact with the patient’s environment). Gloves should be removed and discarded into a no-touch waste receptacle.
Hand hygiene should be performed after removing gloves, upon exiting the patient’s room.Gowns
A long-sleeved gown should be worn upon entering the patient’s room. The gown should be removed and discarded into a no-touch receptacle.
Hand hygiene should be performed after removing gowns, upon exiting the patient’s room.
Facial protection
Facial protection (masks and eye protection, or face shields, or mask with visor attachment) should be worn when within two metres of a patient suspected or confirmed with H7N9 infection. Facial protection should be removed after gloves and gown before leaving the patient’s room and discarded in a hands-free waste and linen receptacle within the room.
Hand hygiene should be performed after removing gloves and gown, before removing facial protection, and after leaving the room.
In a shared room/cohort setting of patients with confirmed H7N9 infection, facial protection may be worn for the care of successive patients.
Respiratory Protection
Wearing a respirator is recommended when performing aerosol generating medical procedures on a patient suspected or confirmed with H7N9 infection (refer to Section 12).
Appendix A) before each patient interaction to evaluate the likelihood of exposure.
HCWs should use a point-of-care risk assessment approach (
<SNIP>
AEROSOL GENERATING MEDICAL PROCEDURES (AGMPs)
AGMPs should be performed on patients suspected or confirmed to have H7N9 infection only if medically necessary. The number of HCWs present during an AGMP should be limited to only those essential for patient care and support. A respirator and face/eye protection is recommended for all HCWs present in a room where an AGMP is being performed on a patient suspected or confirmed to have H7N9 infection.
AGMPs should be performed in airborne infection isolation rooms, whenever feasible. If not feasible, AGMPs should be carried out using a process and in an environment that minimizes the exposure risk for HCWs, ensuring that non-infected patients/visitors and others in the healthcare setting are not unnecessarily exposed to the H7N9 virus.
The most striking differences between the CDC and the PHAC recommendations are the minimum standards for respiratory protective gear for HCWs in contact with H7N9 cases (U.S. = N95, Canada =Surgical/procedure Mask) and the preferred placement of patients (US= AIIR, Canada = Private room).
The Canadian recommendations do call for N95 respirators for HCWs performing AGMPs.
Admittedly, we have finite supplies of N95 respirators and shortages are likely during a severe pandemic, and the availability of AIIR facilities would dwindle quickly during an epidemic of any size.
So in practical terms, the tougher U.S. guidelines would likely need some adjustments once a certain threshold of cases are reached.
As far as relative merits of surgical masks versus N95 respirators are concerned, we’ve covered this contentious debate often, including:
Influenza Transmission, PPEs & `Super Emitters’
Study: Aerosolized Influenza And PPEs
Study: Longevity Of Viruses On PPEs
Why Size Matters
IOM: PPEs For HCWs 2010 Update
