Giuseppe
Emeritus
Novel H1N1 Influenza and Respiratory Protection for Health Care Workers (N Engl J Med., extract, edited)
Published at www.nejm.org September 30, 2009 (10.1056/NEJMp0908437)
Novel H1N1 Influenza and Respiratory Protection for Health Care Workers
Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D.
Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have been asked to consult on the case of a 28-year-old woman who is in an isolation room because of an influenza-like presentation and shortness of breath. You put on a gown, carefully clean your hands with hand soap or an alcoholic gel, pull on gloves, and reach for a mask.
Guidelines from the Centers for Disease Control and Prevention (CDC) recommend the use of an N95 filtering facepiece respirator.
Some states and many professional groups have suggested that a standard surgical mask is satisfactory in this situation, except when a clinician is performing high-risk procedures, such as airway suctioning, in which case the N95 is still recommended. What should the hospital and its infection-control officer provide when you reach into the box for a respiratory protective device?
What should be available to others who will enter this room, including nurses, respiratory technicians, cleaners, and food servers?
On September 3, 2009, the Institute of Medicine (IOM), which has conducted studies on personal protective equipment for health care workers,1 released a report entitled Respiratory Protection for Healthcare Workers in the Workplace against Novel H1N1 Influenza A.2
The report was based on our IOM committee's review of the scientific evidence about the efficacy of personal respiratory protection measures, medical masks, and respirators.
Seasonal influenza usually peaks in the winter months, and each year in the United States there are about 36,000 deaths and 200,000 hospitalizations associated with influenza.3 Seasonal influenza disproportionately attacks the very young and the elderly, in addition to persons who have chronic conditions or are immunocompromised. The novel H1N1 influenza A virus, by contrast, has generally been affecting young and middle-aged people, including pregnant women. This population includes most active members of the workforce, including health care workers.
Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use were not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%.4
These masks ? which are open on the sides, top, and bottom ? may be useful in source control when worn by a patient, but even then, there is evidence that material escapes around the mask's margins after a sneeze or forcible cough. By contrast, respirators cover the nose and mouth (at a minimum) and are designed to purify the air that the wearer breathes in, either by filtering it or by providing an independent air supply.
(...)
-
------
<cite cite="http://content.nejm.org/cgi/content/full/NEJMp0908437?query=TOC">NEJM -- Novel H1N1 Influenza and Respiratory Protection for Health Care Workers</cite>Novel H1N1 Influenza and Respiratory Protection for Health Care Workers
Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D.
Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have been asked to consult on the case of a 28-year-old woman who is in an isolation room because of an influenza-like presentation and shortness of breath. You put on a gown, carefully clean your hands with hand soap or an alcoholic gel, pull on gloves, and reach for a mask.
Guidelines from the Centers for Disease Control and Prevention (CDC) recommend the use of an N95 filtering facepiece respirator.
Some states and many professional groups have suggested that a standard surgical mask is satisfactory in this situation, except when a clinician is performing high-risk procedures, such as airway suctioning, in which case the N95 is still recommended. What should the hospital and its infection-control officer provide when you reach into the box for a respiratory protective device?
What should be available to others who will enter this room, including nurses, respiratory technicians, cleaners, and food servers?
On September 3, 2009, the Institute of Medicine (IOM), which has conducted studies on personal protective equipment for health care workers,1 released a report entitled Respiratory Protection for Healthcare Workers in the Workplace against Novel H1N1 Influenza A.2
The report was based on our IOM committee's review of the scientific evidence about the efficacy of personal respiratory protection measures, medical masks, and respirators.
Seasonal influenza usually peaks in the winter months, and each year in the United States there are about 36,000 deaths and 200,000 hospitalizations associated with influenza.3 Seasonal influenza disproportionately attacks the very young and the elderly, in addition to persons who have chronic conditions or are immunocompromised. The novel H1N1 influenza A virus, by contrast, has generally been affecting young and middle-aged people, including pregnant women. This population includes most active members of the workforce, including health care workers.
Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use were not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%.4
These masks ? which are open on the sides, top, and bottom ? may be useful in source control when worn by a patient, but even then, there is evidence that material escapes around the mask's margins after a sneeze or forcible cough. By contrast, respirators cover the nose and mouth (at a minimum) and are designed to purify the air that the wearer breathes in, either by filtering it or by providing an independent air supply.
(...)
-
------