CDC and OSHA require N95s to protect healthcare workers from H1N1

By: October 15th, 2009 Email This Post Print This Post

The CDC’s says that fit-tested N95 respirators provide the best protection to healthcare workers from H1N1, and OSHA says that employers better be prepared to follow these guidelines.

On October 14, the CDC updated Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel to recommend: “Respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza.” Close contact, as defined by the CDC, means “working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room).”

Immediately following the CDC’s update, OSHA posted a news release on enforcement ramifications. The agency will soon issue a compliance directive that will closely follow the CDC interim guidance to ensure uniform procedures when conducting inspections.

Both agencies recognize that supply issues might force healthcare facilities to prioritize allocation of N95 respirators. “Where respirators are not commercially available, an employer will be considered to be in compliance if the employer can show that a good faith effort has been made to acquire respirators,” said Acting Assistant Secretary of Labor Jordan Barab.

The Society for Healthcare Epidemiology of America (SHEA), which has favored surgical masks over respirators, quickly weighed in by criticizing the CDC’s N95 decision.

“N95s are neither necessary nor practical in protecting healthcare workers and patients against H1N1,” says Mark Rupp, MD of the University of Nebraska Medical Center and President of SHEA. “The best science available leaves no doubt that the best way to protect people is by vaccinating them.”

Comments

By Linda Routsong RN on October 19th, 2009 at 5:14 pm

I guess I am not following the logic of using N95 masks, when influenza is not airborne. We have always been taught to use droplet precautions and wear a mask if within 3 feet of the patient. What do you know, that we do not? Are you saying it is airborne? If not, then surgical masks should work well.

By Barbara Kane RN on October 20th, 2009 at 8:23 am

Does Osha state that we must have the N95 masks available for our employees. Working in a specialist office, how would you know if some one has the flu to use these?

By David LaHoda on October 20th, 2009 at 4:39 pm

You might want to keep a lookout for the compliance directive mentioned above for OSHA’s fine tuning of enforcement on this issue.

As with anything OSHA-related, it is based on the hazards that are present.

If your practice has administrative, engineering, or work practice controls, such as screening out patients who present with influenza or influenza like symptoms, then you would not need a respiratory protection plan which calls for the use of N95 respirators.

If you don’t have those controls, then OSHA, following the recommendations of the CDC, says you must provide respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza.

And the CDC defines close contact as “working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room)

For example, if I have an appointment with your practice, and I show up with influenza symptoms, are you going to take me as scheduled. If so, is the treatment going to require you to be within six feet of me in enclosed airspace.

Yes to both those answers means you must protect your employees with N95s.

As for your contention that by working in a specialist’s practice you would not know if patients have the flu or not, the CDC says that elimination of potential exposures is the first in the hierarchy of controls for prevention of influenza transmission in healthcare settings.

“Eliminating the potential source of exposure ranks highest in the hierarchy of controls. Examples of interventions in this category include: taking steps to minimize outpatient visits for patients with mild influenza-like illness who do not have risk factors for complications, postponing elective visits by patients with suspected or confirmed influenza until they are no longer infectious, and denying entry to visitors who are sick.”

By David LaHoda on October 20th, 2009 at 4:56 pm

The CDC’s Questions and Answers about CDC’s Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel directly addresses this issue:

“Q. Why are the recommendations for respiratory protection of healthcare workers different for 2009 H1N1 influenza and seasonal influenza?

The respiratory protection recommendations for healthcare personnel for protection against 2009 H1N1 differ from recommendations for seasonal influenza as there is little pre-existing immunity to the 2009 H1N1 strain in the population, including healthcare personnel.”

By JS Champagne on October 21st, 2009 at 1:34 pm

Following these guidelines will not be problematic as long as the federal govenment will guarantee an infinite supply of N95’s to all healthcare personnel for as long as needed. However, it has already been mentioned keeping up with demand has been an issue. Why not use common sense and unless this disease is actually airborne and not droplet, move to using surgical masks when appropriate.

I am concerned with the reuse of the mask. I realize that stockpiles are low, but does one problem necessitate doing something that we know is a breach of infection control procedures? I suppose when faced with no masks, one would have to resort to the reuse of existing supplies. However, practicing unsafe procedures at this time places healthcare workers at increased risk. I would agree that the logical path is to push for supplies of n95s for the immediate future and then vaccinate asap.

 

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