October 15, 2009 | | Comments 0
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CDC revisions continue to recommend N95 use, but acknowledge supply shortages

The CDC issued revised interim guidelines yesterday to protect healthcare workers from the H1N1 swine flu virus.

The biggest news is that the CDC continues to recommend that healthcare workers wear N95 respirators when in close contact (i.e., within 6 ft.) of patients with suspected or confirmed H1H1.

However, the CDC also noted N95 supply concerns and recommends a variety of measures that may help conserve respirators and other personal protective equipment (PPE). “For example, combining the use of triage procedures and use of partitions or other engineering controls might reduce exposures and the need for PPE,” the interim guidelines state. Facilities might also choose to use other respirators, such as powered air-purifying respirators, or extend the typical use of an N95.

Should a hospital experience N95 shortages, the CDC recommends establishing a prioritized approach to respirator use, with employees most at risk from H1N1 exposure receiving the N95s first. In such priority situations, surgical face masks can be substituted for N95s.

“If a facility is in prioritized respirator use mode and unable to provide respirators to healthcare personnel who provide care to suspected and confirmed 2009 H1N1 influenza cases, the facility should provide those personnel with facemasks,” the CDC states.

The CDC notes that OSHA rules must be adhered to under the respiratory protection standard. Shortly after the CDC published its revised guidelines, OSHA issued a press release saying it expects hospitals to follow the CDC’s recommendations. Acting Assistant Secretary of Labor Jordan Barab emphasized if N95 respirators are not available, hospitals must show “that a good faith effort has been made to acquire respirators,” according to OSHA.

“The employer will also need to implement a hierarchy of controls, such as feasible engineering controls, administrative controls, and the use, as appropriate, of personal protective equipment, such as gloves and respirators, to protect workers while providing close-contact care,” OSHA added, mirroring what the CDC said.

In response, the Society for Healthcare Epidemiology of America (SHEA) expressed concerns about the CDC’s continued recommendations for N95s.

“Our position was and continues to be that N95s are neither necessary nor practical in protecting healthcare workers and patients against H1N1,” Mark Rupp, MD, president of SHEA, said in a statement. “The best science available leaves no doubt that the best way to protect people is by vaccinating them.”

However, Rupp also supported the CDC’s multi-pronged approach to H1N1 prevention among healthcare workers.

Other revisions by the CDC include the following:

  • Isolation precautions for patients who have flu symptoms should continue for seven days after illness onset or until 24 hours after fever and respiratory symptoms end, whichever is longer, while a patient is in a healthcare facility. If isolation rooms become limited, these spaces should be prioritized for patients who are earlier in the course of illness.
  • Healthcare workers who have a fever and respiratory symptoms should stay home from work for at least 24 hours after they no longer have a fever, without the use of fever-reducing medicines. Previously ill employees returning to work in areas treating severely immunocompromised patients should instead receive temporary reassignment or exclusion from work for seven days from symptom onset or until the resolution of symptoms, whichever is longer.
  • Healthcare workers in close contact with patients with suspected or confirmed 2009 should use nonsterile gloves for any contact with potentially infectious material, followed by hand hygiene immediately after glove removal. Workers should wear gowns and eye protection for any activity that might generate splashes of respiratory secretions or other infectious material.

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Filed Under: CDC/infection controlEmergency managementOSHA

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Scott Wallask About the Author: Scott Wallask is senior managing editor for HCPro's Hospital Safety Center (www.hospitalsafetycenter.com) and the award-winning newsletters, Briefings on Hospital Safety and Healthcare Life Safety Compliance. He has written about healthcare for HCPro since 1998, with a focus on occupational and building safety, emergency management, fire protection, and infection control. Prior to joining HCPro, he worked as a reporter for several newspapers in eastern Massachusetts. He holds a BA in print journalism, magna cum laude, from Northeastern University in Boston. Contact Scott at swallask@hcpro.com.

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