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N95 Respirators are the H1N1 Prevention Winner

David LaHoda, October 28, 2009

Did your healthcare facility cover the spread on H1N1 respiratory protection? If not, your facility is probably scrambling to acquire N95 respirators and figuring out how to fit-test and educate employees on their use.

At the risk of delving into Monday-morning quarterbacking, did you really think the CDC was going to say it was OK to use surgical masks over the more highly-protective N95 respirators in protecting U.S. healthcare workers from H1N1 influenza? Apparently, others thought so, too.

Since the CDC first promoted the use of respirators in its interim guidance during the pandemic preseason in May, there has been controversy about whether H1N1 infectious transmission dynamic were essential droplet or airborne.

Droplet argues well for masks while an airborne dynamic suggests N95 respirators. And many fans lined up on both sides. Of note, the Society for Healthcare Epidemiology of America (SHEA) and the AHA favored masks; for the most part, nurses associations, labor organizations, and the Institute of Medicine (IOM) cheered on N95s. Some experts believed the IOM was better with more recent scientific studies than SHEA when developing their positions.

The ruling on the field, which the CDC revised on October 14, is for "respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza." Close contact, as defined by the CDC, means "working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room)."

The interim guidance does recognize that respirator shortages may occur and allows for healthcare facilities "to develop a risk assessment by which respirators in clinically short supply can be issued on a priority basis," according to the interim guidance. Also the interim guidance applies to both inpatient and outpatient settings, including home heath and clinical setting within non-healthcare institutions such as schools.

Meanwhile, OSHA was warming up on the sidelines as it issued an announcement—on the same day as the interim guidance—about an upcoming "compliance directive that will closely follow the CDC interim guidance to ensure uniform procedures when conducting inspections."

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