October 28, 2009 | | Comments 4
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OSHA raises the stakes in the N95 respirator debate

The October 20 edition of our free sister e-newsletter, OSHA Healthcare Connection, has generated a fair amount of what I like to think of as consternation.

At this point, I think most folks are familiar with the CDC coming down squarely on the side of N95 respirators versus surgical masks for use as personal protective equipment during our little H1N1 event.

I’ve heard from some folks whose infectious disease physicians are indicating that there is a decided dearth of scientific data to support the unilateral adoption of the N95s. In some instances, these physicians are recommending the use of surgical masks for H1N1 patients, quite in opposition to the CDC’s position.

Where this gets kind of interesting (in this case a euphemism for scary) is that OSHA is has weighed in on the topic and basically echoes the stance of the folks at the CDC, which substantially increases the ante in terms of worker protection, employer liability, and all sorts of other regulatory pitfalls.

And to boot, OSHA and the CDC have come down on the side of technology that is already, at least in my experiences with hospitals across the country, in short supply. Now I know that appropriate levels of protection are appropriate levels of protection, and if the N95 is what works best, there is naught to be done.

But — and isn’t there always a but — what happens if the most dire of predictions actually comes true on this? We’re already dealing with shortfalls of vaccine, which ideally would provide some preventive support, but what then do we do if, or perhaps when, the N95 well runs dry? Will healthcare organizations end up funding the public health insurance option through OSHA fines?

I don’t see how, at least at the moment, healthcare organizations don’t end up taking it on the chin. The risk is known and it is well-tracked, so how does that not equate with OSHA ugliness?

I’d like to say that I can pull a rabbit out of the hat for this one, but the rabbits all appear to be taking cover (very clever little bunnies, I think). And what’s this announcement going to do to other folks who might decide they can’t live without protection and start competing with healthcare (and yes, I did indeed check and you can purchase N95 respirators on e-Bay).

So, I put it to you my ever-inventive readers: What’s this all mean to you? Keeping you up at night? If not, what’s your secret? This is a time for sharing – let us know.

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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  1. So, how are other organizations coping with the current shortage of N-95 respirators? Since December of last year we’ve been having difficulty maintaining par levels, let alone securing extras in anticipation of an epidemic. Our suppliers tell us they can’t get them because they’re being held in the overseas countries where they’re manufactured. Yet I hear no other hospital talking about it.

    A task force we put together to manage an epidemic has recommended that we temporarily stop conducting required annual fit testing, since that essentially wastes at least one respirator per candidate. I seriously doubt OSHA would grant a temporary variance in this situation.

    What creative ideas are other organizations coming up with to acquire and conserve N-95 respirators in preparation for The Big One?

  2. Steve:

    I agree with you about the effect the CDC and OSHA decisions are having on all healthcare settings.

    The anxiety was obvious in the tone of questions at the Premier, Inc. webinar, H1N1 Preparedness–Lessons Learned & Successful Strategies webinar yesterday about which I write today on the OSHA Healthcare Advisor, Fast-track guide to H1N1 OSHA compliance.

    One of the points made by the CDC participant was that OSHA enforcement is likely to be flexible if healthcare facilities work through the hierarchy of controls, make a good faith attempt to procure and prioritize N95 use, adapt their policies to local and state health departments, and, very important here, document these efforts.

    With all that in mind, I imagine it is very stressful to be responsible for safety in a healthcare facility right now.

  3. N95s may be purchased at numerous business, but are not approved for Medical use.

  4. This whole thing is a joke. The CDC painted themselves in a corner recommending N-95’s for all care. We have protected medical providers with surgical masks for years…THIS IS THE SAME SPREAD! The CDC fails to mention eye protection for employees…to require a fit tested respirator and not cover your eyes is sad! Studies have proven that the mask/eyeshield provide the SAME LEVEL of protection as N-95’s. And what about PAPRS????? Well, this is a droplet disease so to reuse over and over and not clean EVERYTIME is a risk. OSHA did add the little point that when doing aerosolyzing procedures and other airborne illnesses such as Tb that regardless of the shortage an organization MUST provide a respirator. So they want us to use N-95’s (for about 2 weeks until we run dangerously low) then hold switch staff back to masks because that is all we have…yeah, nice call. And these other supplies of N-95’s, if it isn’t the same model you have to re-fittest everyone.

    By the way…next year when this is part of the circulating seasonal flu are we going to go back?

    This is a sad, sad state of affairs and the CDC has let us down and OSHA simply cut and pasted from CDC and completely disregards what science says.

    Way to go govenment!

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