As influenza season draws nearer, public health experts are debating the best ways to protect health care workers (HCWs) from novel H1N1. IDSA joined the Society for Healthcare Epidemiology of America (SHEA) and other groups in calling for an evidence-based approach that emphasizes adherence to basic infection control practices, based on their conclusion that the current strain of novel H1N1 has the same transmission dynamics as seasonal influenza.
IDSA and SHEA made their recommendations in a joint statement presented to a task force of the Institute of Medicine (IOM) in mid-August. The IOM task force is charged with making recommendations to the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) by Sept. 1. CDC currently recommends that HCWs who enter the room of a patient in isolation for suspected or confirmed novel H1N1 influenza should wear N95 respirators or equivalent protection, but currently the science does not appear to support this approach.
Prudent measures, according to SHEA and IDSA, require rigorous and consistent application of basic infection control and personal hygiene practices including: adherence to hand hygiene and cough etiquette, rapid identification and separation of patients with the virus, and utilization of appropriate personal protective equipment – surgical masks, in the case of droplet transmissible diseases like H1N1.
For certain procedures that could potentially “aerosolize” the virus, thereby allowing for airborne transmission, IDSA and SHEA advise that health care workers should wear respirators. Such procedures include: bronchoscopy, open suctioning of airway secretions, resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation.
“Surgical masks provide the level of protection needed for health care workers who may be exposed to the H1N1 virus. Using respirators in situations other than when there is the potential for the virus to become aerosolized is not wise,” said IDSA President Anne Gershon, MD, FIDSA. “Respirators do not provide increased protection against the H1N1 virus. Inappropriate use could result in a shortage of the respirators, which are essential to the prevention and control of truly airborne pathogens such as tuberculosis. This would put health care workers and patients at even greater risk,” Dr. Gershon added.
Another critical component to an appropriate response to the H1N1 virus, according to the groups, is avoiding implementation of automatic reassignment of high-risk health care workers who could be exposed to the virus. The current protocol provides sufficient protection, and reassignment wrongfully implies this is not the case, IDSA, SHEA, the Association for Professionals in Infection Control and Epidemiology (APIC), and the American College of Occupational and Environmental Medicine (ACOEM) said in a recent joint statement.
Finally, the groups note that transmission of both seasonal and pandemic influenza occurs primarily in the community rather than in health care settings. “Therefore, two other critical control measures are early recognition and separation (isolation) of suspected novel H1N1-infected patients upon presentation to a health care facility and restriction of visitors and health care workers with febrile respiratory illnesses,” said the IDSA-SHEA statement to the IOM, which was presented by Lisa Maragakis, MD, MPH, of the Johns Hopkins Medical Institutions. “Without consistent application of these infection prevention measures in our health care institutions, no level of respiratory protection will offer adequate prevention of influenza transmission,” Dr. Maragakis’s statement said.
For more on the IOM task force, see www.iom.edu/?ID=71769.
For more on IDSA and SHEA’s position, see this June 2009 IDSA News article.
For updated guidance documents from CDC and other sources on diagnostics, infection control, antiviral use, and related matters, see the IDSA web page on seasonal and H1N1 influenza. To receive the latest notices from CDC’s Health Alert Network and the Food and Drug Administration—on H1N1 and other timely topics—click here (you must be logged in to have access to this link).
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