The Centers for Disease Control and Prevention (CDC) in mid-October issued its latest guidance on preventing the transmission of novel H1N1 influenza in health care settings. CDC emphasized a multipronged approach, but affirmed its earlier recommendation that health care workers (HCWs) in close contact with patients with confirmed or suspected cases of H1N1 wear N95 respirators.

CDC advises health care facilities to use a hierarchy of controls, including personal protective equipment as one element, to prevent the transmission of influenza and help facilities get the most benefit from  respirator supplies, the availability of which CDC acknowledges is already an issue at many institutions. In its guidance, CDC highlights the fundamental importance of immunizing HCWs against H1N1. After immunizations, CDC’s hierarchy of controls, from highest rank to lowest priority, include:

• Eliminating potential exposures, such as postponing elective visits by patients with suspected or confirmed influenza, or minimizing outpatient visits for patients with mild influenza-like illness who are not at risk for complications
• Engineering controls, which might involve installing partitions in triage areas and other public spaces
• Administrative controls, such as promoting and providing influenza vaccination, enforcing policies about working when sick, and implementing hand and cough hygiene strategies
• Personal protective equipment

While the guidance calls for HCWs to wear N95 respirators, fit-tested to meet Occupational Safety and Health Administration (OSHA) requirements, when caring for H1N1 patients, it also details other options when respirators are in short supply. These include prioritizing respirator use, keeping in mind the duration and intensity of exposure, personal risk factors for complications of infection, and vaccination status. Under these priority conditions, CDC advises, HCWs who do not receive respirators should wear surgical masks. The updated guidance notes that the recommendations will be updated as necessary as new information becomes available.

IDSA shares the practical concerns about CDC’s guidance regarding the use of respirators voiced by the Society for Healthcare Epidemiology (SHEA), which issued a press release in response to CDC’s updated recommendations. Both SHEA and IDSA have stressed the importance of a range of infection control measures, including immunization against influenza, to prevent the transmission of H1N1, most notably in statement presented at a recent Institute of Medicine forum. IDSA also recently adopted a strengthened policy supporting mandatory immunization of HCWs as the most effective way to protect both patients and HCWs against H1N1 and seasonal influenza (see IDSA News article).

To read more about CDC’s latest recommendations, see this story from the Center for Infectious Disease Research and Policy.

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