The significance of this is that N95 respirators must be fit-tested to individuals. Each person’s face is different—they must be measured and have a personal mask, fitted to their measurements, available for their use when caring for patients suspected or confirmed of having H1N1, according to the Institute of Medicine—ie, IOM is making a demand of hospitals who expect workers to care for H1N1 patients.
Report available at: http://www.nap.edu/catalog.php?record_id=12748
Copyright 2009 by Virgo Publishing. http://www.infectioncontroltoday.com/ Posted on: 01/01/2075
Healthcare workers who interact with patients suspected or confirmed to be infected with novel H1N1 influenza A — the new strain of pandemic flu — should wear fitted N95 respirators, which filter better than looser medical masks, to help guard against respiratory infection by the virus, says a new report from the Institute of Medicine. The report endorses the current U.S. Centers for Disease Control and Prevention guidelines for respiratory protection against this novel flu virus, also commonly referred to as swine flu. However, wearing N95 respirators should be only one element of workers’ and healthcare organizations’ infection control strategies, stressed the committee that wrote the report.
While the CDC guidelines and the report’s recommendations are based on the best available information and evidence, scientists do not know to what extent flu viruses spread through the air or whether infection requires physical contact with contaminated fluids or surfaces. The report calls for a boost in research to answer these questions and to design and develop better protective equipment that would enhance workers’ comfort, safety, and ability to do their jobs.
"Based on what we currently know about influenza, well-fitted N95 respirators offer healthcare workers the best protection against inhalation of viral particles," said committee chair Kenneth Shine, executive vice chancellor for health affairs for the University of Texas System in Austin, and former president of the Institute of Medicine. "But there is a lot we still don’t know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield. Healthcare organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, handwashing, disinfection, gloves, vaccination and antiviral drug use."
In the event that the new pandemic virus creates a surge of patients during the upcoming flu season, it will be critical to protect healthcare workers from infection given their central role in treating sick people and lessening the pandemic’s overall impact.
The Institute of Medicine was asked to evaluate personal protective equipment designed to guard against respiratory infection specifically, and therefore the committee focused on the efficacy of medical masks and respirators. Studies have shown that inhalation of airborne viruses is a likely route of flu infection, supporting the use of respiratory protection during an outbreak even though it is not clear whether airborne transmission is the sole or main way the disease spreads.
N95 respirators and medical masks cover the nose and mouth. Although similar in appearance, medical masks fit loosely on wearers’ faces, and respirators are designed to form a tight seal against the wearer’s skin. If properly fitted and worn correctly, N95 respirators filter out at least 95 percent of particles as small as 0.3 micrometers, which is smaller than influenza viruses, the report notes.
Given the short time frame of this study, the committee was not asked to discuss issues associated with implementing its recommendations, such as costs and supplies, or to assess the impact of other infection control measures, such as vaccination or prophylactic use of antiviral drugs. However, the committee underscored the importance of using a range of infection control strategies to minimize the chances for exposure and infection for healthcare workers.
The study was sponsored by the CDC and Occupational Safety and Health Administration. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.
The following are the IOM’s recommendations:
Recommendation 1: Use Fit-Tested N95 Respirators
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.
- The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.
- Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations, and healthcare workers should use the equipment as required by regulations and employer policies.
Recommendation 2: Increase Research on Influenza Transmission and Personal Respiratory Protection
CDC centers (e.g., National Institute for Occupational Safety and Health; National Center for Immunization and Respiratory Diseases; National Center for Preparedness, Detection, and Control of Infectious Diseases), the National Institutes of Health, and other relevant federal agencies and private institutions should fund and undertake additional research to:
- resolve the unanswered questions regarding the relative contribution of various routes of influenza transmission
- fully explore the effectiveness of personal respiratory protection technologies in a variety of clinical settings through randomized clinical trials
- design and develop the next generation of personal respiratory protection technologies for healthcare workers to enhance safety, comfort, and ability to perform work-related tasks.