Surgical Facemask vs. N-95 Respirator
# 7927
Dr. Ian Mackay has a good post this morning on a recent correspondence to the editors of the NEJM on what appears to be lax infection control standards for hospitals in Saudi Arabia dealing with outbreaks of the MERS coronavirus.
Follow the link below to read his comments, after which I’ll return with a little more:
The CDC’s interim guidance for MERS-CoV infection control is very stringent, and it is based on a number of considerations:
- Suspected high rate of morbidity and mortality among infected patients
- Evidence of limited human-to-human transmission
- Poorly characterized clinical signs and symptoms
- Unknown modes of transmission of MERS-CoV
- Lack of a vaccine and chemoprophylaxis
In their reply to this correspondence in the NEJM, Dr. Ziad A. Memish et al. wrote:
The infection-control measures applied in the Al-Hasa outbreak probably contributed to the control of the outbreak and were consistent with the World Health Organization's interim infection-control guidance, which is based on the available scientific evidence.
The WHO infection control guidance, issued last May, recommends `medical masks’ (defined as disposable surgical or procedure mask) - as opposed to the more protective N95 respirators - for healthcare workers (HCWs) in close proximity (1 meter) to suspected or confirmed nCoV cases. N95 respirators are recommended for staff performing `aerosol generating procedures’ on known or suspected MERS cases.
In terms of practicality, no doubt many resource-limited nations would find it difficult to provide the kind of robust infection control recommended by the CDC (AIIR rooms, N95 respirators, etc.). A factor I’m certain went into the WHO’s guidance decisions.
But Saudi Arabia is hardly a resource limited nation. Which makes their reliance upon a lower infection control standard hard to fathom, particularly in light of reports suggestive of ongoing nosocomial infection in recent months.
