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Nov./Dec. 2009
Vol. 19 No. 11
Policy and Advocacy
IDSA, Other Experts Urge White House to Modify H1N1 Guidance for Health Care Workers

IDSA joined the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) in November in urging the Obama administration to update current federal guidance concerning the use of personal protective equipment (PPE) by health care workers (HCWs) in treating suspected or confirmed cases of 2009 H1N1 influenza.

In a letter to the White House, the three groups also urged the administration to issue an immediate moratorium on the Occupational Safety and Health Administration’s (OSHA) enforcement of the current requirements. As expected, OSHA on Nov. 20 released a compliance directive, which lays out OSHA enforcement procedures that follow current recommendations from the Centers for Disease Control and Prevention (CDC).

CDC's recommendations, issued in October as interim guidance, state that workers in close contact with influenza patients should wear N-95 respirators, rather than standard surgical masks.  However, CDC noted that N-95s are just one part of a comprehensive approach, and that when in short supply, respirators should be reserved for high-risk situations, such as aerosol-generating procedures.

IDSA and the other infection control experts contend that the current guidance does not reflect the best available scientific evidence, citing two recent studies demonstrating that N-95s do not offer better protection than surgical masks. In the first study (Loeb, et al. JAMA. 2009;302(17):1865-1871.), no significant difference in influenza acquisition was observed in nurses in Toronto assigned to wear N-95 respirators or surgical masks.

The second study, a re-evaluation of a study performed in China (MacIntyre, et al.), was presented at the 47th Annual Meeting of IDSA last month in Philadelphia.  Investigators from Australia presented a new analysis of their data, made at the request of peer reviewers who had asked that the control group of unprotected workers be dropped, because those workers had not been randomly assigned to not wear protection. The result was that there was no longer a statistical difference between those who wore N-95s and those who wore surgical masks. Dr. MacIntyre asserts that the study results still indicate a real difference in levels of protection, but IDSA and SHEA leaders believe the re-analysis undermines that conclusion. To listen to the IDSA abstract oral presentation, click here.

“During a time of a national emergency, health care professionals need clear, practical, and evidence-based guidance from the government,” said IDSA President Richard Whitley, MD, FIDSA. “The current guidance is not supported by the best-available science and only serves to create skepticism toward federal public and occupational health decision-making.”

SHEA President Mark Rupp, MD, called the current requirements “deeply flawed” and expressed concern over the “potential for considerable untoward consequences”—such as limiting the availability of the already scarce respirators in situations where they are truly warranted.

The groups maintain that other strategies—among them, immunization—would provide better protection for HCWs (see related story). Although the groups support continued research on the route of H1N1 transmission and means of prevention, their letter to the White House says that “until and unless such evidence exists, the current federal PPE guidance and OSHA requirements remain deeply flawed with considerable consequences.”

As of Dec. 3, the groups have received no response from the administration.
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