WASHINGTON Surgical mask or N95 respirator? The question of whether the Centers for Disease Control and Prevention should advise the use of respirators as standard protective gear by health care workers at risk for exposure to the novel influenza A(H1N1) virus was featured at a workshop sponsored by the Institute of Medicine.
The workshop served as "an open, on-the-record, information-gathering session" for the Institute of Medicine's Committee on Personal Protective Equipment [PPE] for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A, said Dr. Kenneth Shine, chair of the committee. The committee is charged with sending a draft report to the CDC with recommendations for updated guidance on H1N1-related PPE for health care workers.
Regardless of any changes in recommendations, PPE is only one layer in a health care worker's protection against the virus, said Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit.
"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained. Other measures to control the spread of the novel H1N1 virus currently recommended by the CDC include wearing gloves and gowns when in contact with infected persons, practicing proper hand hygiene, covering coughs and sneezes, and isolating individuals who appear ill.
"There's no such thing as a risk-free environment," said Dr. Rosemary Sokas of the Occupational Safety and Health Administration. But Dr. Sokas emphasized that employers are responsible for providing workers with the highest level of protection possible. At the workshop, the committee heard results of several studies about the use of PPE in preventing flu transmission.
In one study, Dr. Raina MacIntyre of the University of New South Wales, Australia, and her colleagues conducted a randomized, controlled trial of more than 1,000 health care workers in 24 hospitals in Beijing.
The study compared infection rates in individuals who wore surgical masks, N95 respirators that were fit tested, N95 respirators that were not fit tested, and controls. The respiratorsregardless of whether they were fit testedwere more effective than either surgical masks or controls.
There was no significant difference in effectiveness between the fit-tested and non-fit-tested N95 respirators. The complete study results will be presented at the upcoming Interscience Conference on Antimicrobial Agents and Chemotherapy meeting this month, Dr. MacIntyre said.
Despite such findings supporting the use of N95 respirators to mitigate the spread of the H1N1 virus, requiring their use might not go over well with clinicians in the trenches, said Dr. Alexander Isakov, an emergency medicine physician from Emory University in Atlanta. Dr. Isakov also serves as director of Emory's Section on Prehospital and Disaster Medicine, and as director of the Emory Office of Critical Event Preparedness and Response.
In an emergency setting, it is not always immediately clear what is required for each patient, Dr. Isakov said. Emergency departments that are already busy and may not be able to give infected patients adequate time if personnel are burdened with PPE requirements that may not be supported by sufficient evidence, he emphasized.
"The level of PPE required of emergency health care workers does have implications on their ability to do their jobs," Dr. Isakov said. PPE recommendations must be appropriate to the mission of the health care worker, he stressed. "Adding additional burdens on the health care provider for an extra modicum of safety that can't be measured might not actually benefit the health care worker or the patients they are trying to serve," he said.
For example, if doctors take longer to manage patients because they must don full protective gear before entering each room, it could slow down operations and cause more backlogs and crowding, he explained.
The committee also heard from representatives of workers' organizations, including the Service Employees Union and the American Federation of State, County, and Municipal Employees, who expressed support for keeping the current recommendation that health care workers use N95 respirators when managing patients with H1N1.
'The level of PPE required of emergency health care workers does have implications on their ability to do their jobs.'
Source DR. ISAKOV