IOM decides in favor of fit-tested respirators for H1N1
Relying only on current scientific and empirical evidence, the Institute of Medicine (IOM) recommended yesterday that respirators and not surgical masks should be used to protect healthcare workers from H1N1.
“Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators or respirators that are demonstrably more effective as one measure in the continuum of safety and infection control efforts to reduce the risk of infection,” according to “Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A: A Letter Report.”
The IOM report endorses the current CDC guidance, which also calls for N95s over surgical masks, and recommends keeping that guidance in place “until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.”
Also, healthcare employers should follow OSHA standards with regard to fit testing and educating workers for respirator use, says the IOM.
The report was undertaken at the request of the CDC which is reconsidering its interim guidance because of differing opinions on the effectiveness, practicality, and logistics of H1N1 respirator use
Expect the CDC to change or affirm the guidance by early October.
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David LaHoda
David LaHoda, the managing editor of Medical Environment Update and OSHA Watch, has produced healthcare training videos and consulted for medical practices and ambulatory healthcare facilities.
David has written 196 posts.
Comments
hi,
can i receive the osha healthcare advisor on a weekly basis with a list of all the daily reports sent out instead of a daily report?
thanks,
brandan
What are the recommendations for employees returning to work after being diagnosed? Thanks
“CDC recommends that employees with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications,” according to CDC Guidance for Businesses and Employers To Plan and Respond to the 2009–2010 Influenza Season.
Please tell me what the bottom line is, in terms of clinics, regarding the use of N95 respirators. We are an oncology clinic and do not typically see patients for anything other than chemo/radiation therapy. Are we required to have all clinicians and front office staff to be fitted for a respirator?
Thanks
Marie
Here is what I have told readers with similar questions. I think it will be relevant to your situation.
Before you spend lots of time outfitting staff with N95s, make sure to consider administrative, engineering, and work practice controls that might decrease the number of staff who need to wear respirators.
You could establish an administrative control that says your providers will not see or treat patients presenting with H1N1 influenza-like symptoms. While this may seem like and extreme example of a respiratory protection plan, it would be OSHA compliant.
You could institute a work practice control that protects providers by maintaining a safe distance from potentially infectious patients—CDC says somewhere between 3-6 feet, but I’m not exactly sure about that—and requiring patients to wear a surgical mask. That would make use of a respirator unnecessary and requiring compliant respirator use only when in close contact or when engaging in certain procedures that induce aerosol transmission exposure. See the Masking and Separation of Persons with Respiratory Symptoms in Respiratory Hygiene/Cough Etiquette in Healthcare Settings.
Or, you can designate only a portion of your providers to treat H1N1 cases leaving the remainder for non-flu cases.
Admittedly, not all of these may be practical, but perhaps some changes might greatly decrease the number of staff required to wear respirators. And, if you require staff to wear an N95 respirator, you must have a medical evaluation, a fit-test, and training for each worker.
Finally, from a regulatory perspective this may be a moot point if the CDC recommends contact precautions instead of airborne for H1N1. See “On-again, off-again N95 guidelines for H1N1” But then some reports, including the one referenced above, are coming in that lean toward airborne precautions and respirators instead of surgical masks.
Expect a decision by the CDC by the beginning of October.
I thought the surgical mask with eye shield was previously recommended. Is eye protection no longer necessary?
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