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Can Hospitals and Physician Practices Achieve a Win-Win on N95 Respirators?

David LaHoda, September 24, 2009

So much of swine flu preparation news has focused on how hospitals will cope with the pandemic that it was nice to see one organization, the American Hospital Association, sympathize with the challenges facing physician practices.

Since the spring H1N1 outbreak, the healthcare safety community has vigorously debated whether to protect healthcare workers with fit-tested N95 respirators or the more easily used surgical/procedure masks. A September 15 letter urging the CDC to quickly reverse the current recommendations favoring N95s placed the AHA firmly on the mask side of the argument, mainly for epidemiological and supply reasons. The AHA also observed that requiring respirators would give non-hospital settings, such as physician offices, which are unfamiliar with using fit-tested N95s, a disincentive to treat patients with flu-like symptoms, "resulting in a further surge of individuals being inappropriately sent to hospital emergency departments for care."

There is sort of a mild versus severe pandemic balancing act going on here. From the perspective of an outpatient facility, a mild case of H1N1 this winter could actually mean a strong surge for outpatient facilities and physician offices, as Paul Biddinger, MD, medical director for emergency preparedness and emergency physician at Massachusetts General Hospital in Boston, explained in the September issue of Medical Environment Update. "If the second wave [fall and winter] of H1N1 causes mostly mild illness, I think outpatient providers will feel the brunt of the surge of patients. If the virus causes more severe illness, it may be more in the emergency department and in the hospital setting."

But what if the CDC doesn't budge on the AHA's epidemiological and logistical reasons? A recent report by Institute of Medicine expressly favors fit-tested N95s, as do most healthcare worker labor unions and other healthcare professional associations.

Yes, physician offices are unfamiliar and confused about N95 fit testing, judging from calls received through the HCPro OSHA Hotline. Some think it is just a matter of showing workers how to put it on, pinch the metal bridge for the nose, and how to take it off. (See "Don't confuse N95 fit testing with user seal checking".

To hospitals, which regularly conduct fit testing, the N95 recommendation for H1N1 protection admittedly requires extra resources and time, but to the small physician practice, fit-testing probably seems like an insurmountable challenge, what with their lack of experience and expertise.

If you logically extend the AHA's argument, it appears that hospitals and physician practices are in this thing together, whether the CDC says yeah or nay to respirators. That's why the AHA might also recommend that its membership lend assistance to fit-testing staff members of physician practices in their community.


David LaHoda, the managing editor of Medical Environment Update and OSHA Watch, has produced healthcare training videos and consulted for medical practices and ambulatory healthcare facilities.

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