H1N1 respirator vs. mask Xs and Os

By: October 22nd, 2009 Email This Post Print This Post

Did your healthcare facility cover the spread on H1N1 respiratory protection? If not, your facility is probably scrambling to acquire N95 respirators and figuring out how to fit-test and educate employees on their use.

At the risk of delving into Monday-morning quarterbacking, did you really think the CDC was going to say it was OK to use surgical masks over the more highly-protective N95 respirators in protecting U.S. healthcare workers from H1N1 influenza? Apparently, others thought so, too.

Since the CDC first promoted the use of respirators in its interim guidance during the pandemic preseason in May, there has been controversy on whether H1N1 infectious transmission dynamic were essential droplet or airborne.

Droplet argues well for masks while an airborne dynamic suggests N95 respirators. And many fans lined up on both sides. Of note, the Society for Healthcare Epidemiology of America (SHEA) and the AHA favored masks; for the most part, nurses associations, labor organizations, and the Institute of Medicine (IOM) cheered on N95s. Some experts believed the IOM was better with more recent scientific studies than SHEA when developing their positions.

The ruling on the field, which the CDC revised on October 14, is for “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).”

The interim guidance does recognize that respirator shortages may occur and allows for healthcare facilities “to develop a risk assessment by which respirators in clinically short supply can be issued on a priority basis,” according to the interim guidance. Also the interim guidance applies to both inpatient and outpatient settings including home heath and clinical setting within non-healthcare institutions such as school.

Meanwhile, OSHA was warming up on the sidelines as it issued an announcement–on the same day as the interim guidance–about an upcoming “compliance directive that will closely follow the CDC interim guidance to ensure uniform procedures when conducting inspections.”

Within an hour after the news, the HCPro OSHA Compliance hotline started receiving inquiries about the possibility of cutting the fit-testing requirement. The answer, at least for now, according to OSHA: “Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing.” Seems like CDC and OSHA were in the same huddle on this issue.

That kind of last-minute-reprieve thinking isn’t unusual, even though readers of the OSHA Healthcare Advisor have known about this issue for some time. The problem is that unlike football, pandemic influenza preparation is not a spectator sport. And for those healthcare facilities who thought the CDC was going to produce a comeback win in the last to two minutes of the respirator-mask game, time has expired.


Unfortunately with medical practices fighting to survive financially how can we be expected to afford this?? (N95’s) As a long time nurse who WAS practicing in a hospital setting in the 70’s what has happened to common sense using “covering your cough” and MOST important “hand washing” as our first line defense. I cant help but feel the media has started this panic!! I sometimes wonder how I was able to raise my children age 28 and 33 without all these “germ warfare” tactics that the media continues to blast. This AM on Good Morning America there was a blip on washing machines now harboring germs. Where does it end??

By Debbie Clark RRT, MPH on October 23rd, 2009 at 1:23 pm

I agree, esp. since the seasonal flu remains a droplet not airborne precaution. The particle size is the same. The CDC is just caving in to media pressure. FYI, the Florida Dept of Health has also sided with AHA, AMA and SHEA with regards to the surgical masks.

By stuart fong on October 26th, 2009 at 9:12 pm

I resent the fact that you are saying that we did not prepare. I work for a 54-bed, small not-for-profit, independent hospital. We have not recieved our regular order of our N-95 since the end of May; because of the panic that you, the CDC, OSHA, and IOM have created. We have been told many diferent versions of WHY we are not getting the N-95. We have called different companies, medical and industrial and every one is on back order. We have burned through our inventory and back-up supplies. Unfortunately our priority is to use our N-95 mask for our TB patients not the ILI patients. How dare you assume this – because it only makes an ass out of u.
Now that we are in a crisis or declared emergency, I am very much interested to see how the distribution will occur; it is very apparent to me that no one cares about the little guy. I am fortunate to work in San Francisco where other facilities stepped up and shared their limited supplies.

By David LaHoda on October 27th, 2009 at 10:36 am

Maybe in your mind you did prepare adequately, but the CDC and OSHA have been encouraging all healthcare facilities to stockpile personal protective equipment for influenza pandemic response since 2007 (See Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers). That was well before H1N1 appeared on the scene spring of 2009. That there would be shortages of N95s in a pandemic situation certainly could not have caught you by surprise.

I’m glad for your situation that other facilities stepped in to help. And it sounds like you have an established respiratory protection plan. I do know of some facilities that resisted establishing a plan at all and hoped against hope that the CDC and OSHA would approach H1N1 protection with just a wink and nod and dodge ever having to deal with N95 respirators. It was to those types of healthcare facilities that my post was directed. But, I’m glad my post elicited a response from “u.”

I don’t understand this argument.

Many people are not wearing either mask or respirator correctly, so both are basically useless.

IF you do have a proper seal then they both offer adequate protection. N95’s can get down to 0.3 micrometers of filtration and procedure masks can get down to the same level but is usually up around 0.5, given you have a proper seal, and depending on the brands, they both offer the same protection level.

By David LaHoda on October 27th, 2009 at 11:56 am

You seem to have a good understanding of the capabilities of N95 respirators and masks except that mask use is for “protecting patients from the wearers’ respiratory emissions,” and not necessarily the other way around, according to a recent post on the NIOSH Science Blog about which I wrote today, “Getting schooled: N95 and surgical mask 101.”.

Your assertion that they offer the same protection level is not corroborated by the NIOSH post.


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