IDSA News - September 2009
Vol. 19 No. 9  (Plain Text Version)

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In this issue:
Top Stories
•  From the President: Protecting HCWs from Novel H1N1
•  IDSA Annual Meeting Reminders and Updates
•  IDSA Journal Club
Patient Care and Science
•  EIN: H1N1 and HCW Reassignment Questions
•  NIAID Funds Research on Shorter Antimicrobial Regimens
•  “Get Smart” Week Targets Inappropriate Antibiotic Use
•  Drug Approvals, Recalls, Adverse Events Update
Practice Management
•  Annual Meeting Features Helpful Practice Management Sessions
•  What ID Physicians Are Paid
Global ID
•  South African Clinic Successfully Integrates HIV/TB Care
•  New NIH Director Cites Global Health Among Top Priorities
Policy and Advocacy
•  IDSA Urges Changes in Adverse Event Reporting for Research
•  Help Us Oppose Elimination of Consultation Payments
•  IDSA Highlights Ways to Spur Development of New Antibiotics in FDA Meeting
•  HIVMA Urges Health Reformers to Remember People with HIV
•  HIVMA, IDSA Call for Repeal of Needle Exchange Federal Funding Ban
Your Colleagues
•  IDSA Recognized for Combating Antibiotic Resistance
•  Members on the Move
•  Welcome, New Members!
Education & Resources
•  Show Your Commitment to Influenza Vaccination
•  Vaccine Safety Fellowship Available


From the President: Protecting HCWs from Novel H1N1

Since the initial novel H1N1 influenza outbreak last spring, IDSA members have been among the many health care workers (HCWs) on the front lines, providing clinical care to patients with suspected or confirmed cases. 

Since the initial novel H1N1 influenza outbreak last spring, IDSA members have been among the many health care workers (HCWs) on the front lines, providing clinical care to patients with suspected or confirmed cases.

Developing the best ways to protect these workers and the public from this new strain is an important priority for the Society. As officials review the current guidance for appropriate measures, IDSA and other groups, including the Society for Healthcare Epidemiology (SHEA), have provided the valuable perspectives of ID clinicians. More research is needed, but based on the current scientific evidence, IDSA and these groups have concluded that H1N1 spreads much like seasonal influenza, via droplet transmission.

In June, SHEA published a position statement, which IDSA endorsed, that reviewed the evidence and practical considerations and made recommendations. These were in agreement with the evidence-based recommendations of the World Health Organization (WHO) and the Healthcare Infection Control Practices Advisory Committee (HICPAC), the Centers for Disease Control and Prevention (CDC)’s own advisory panel.

IDSA and SHEA also presented a statement in August to an Institute of Medicine (IOM) task force charged with creating its own worker protection guidance for CDC and the Occupational Safety and Health Administration (OSHA). IDSA and SHEA endorsed precautions grounded in basic infection control and personal hygiene practices. The groups also recommended that HCWs use appropriate personal protective equipment—surgical masks—but not N95 respirators, as called for in CDC’s existing guidance, except during procedures that could potentially allow for airborne transmission of H1N1.

Earlier this month, IOM’s subsequent report recommended the use of respirators by HCWs interacting with patients with suspected or confirmed H1N1 influenza. Significantly, IOM noted its report did not address costs, supplies, or the impact of other infection control measures—practical matters that HCWs and institutions must consider. The report’s authors also cited the need for more research, a position that we and other groups share.

Respirators are just one way to protect health care workers. A range of other measures—including hand washing and cough etiquette, vaccination, and other basic infection control practices—are essential in protecting health care providers and patients alike. Inappropriate use could cause a shortage of respirators, making it harder to prevent the spread of truly airborne diseases, like tuberculosis, putting HCWs at even greater risk.

CDC is expected to issue its final guidance on this issue by Oct. 1, and IDSA and colleagues at SHEA have urged officials to consider the perspectives of other groups, including WHO, HICPAC, the Association for Professionals in Infection Control and Epidemiology (APIC), and the Association of State and Territorial Health Officials (ASTHO), all of which share IDSA and SHEA’s position on respirator use.

Another question raised by the response to H1N1 involves whether to reassign high-risk HCWs who could be exposed to the virus. CDC currently recommends such an approach. We joined with several other groups, including SHEA, APIC, and the American College of Occupational and Environmental Medicine (ACOEM), in calling for a change to this recommendation in a joint position statement. While reassignment may sometimes be appropriate on a case-by-case basis, doing so routinely wrongfully implies that current infection control practices are not enough. It also raises serious logistical and worker privacy concerns.

Lastly, it’s worth highlighting one of the most effective protections for health providers against seasonal flu, and hopefully, against H1N1 as well—vaccination. Each year fewer than two in five HCWs are immunized against influenza, a troubling statistic that puts both provider and patient at greater risk. Mandatory seasonal influenza vaccination for HCWs—with the option to opt out in writing for religious, philosophical, or medical reasons—would help plug a critical hole in both worker and patient safety. The risks of adverse effects from influenza surely outweigh those from the vaccine, and the benefits—preventing illness and complications—are substantial.

With influenza season now upon us, IDSA will continue to work with colleagues at other groups and with federal agencies and other institutions to offer our expertise as officials wrestle with how to best protect HCWs and patients from H1N1. As heath care providers ourselves, it’s a responsibility we take seriously.