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Editor's note: For additional articles on H1N1, click here. To earn continuing education credit on the H1N1 virus, click here.
CDC officials are recommending anyone entering the hospital room of a patient with suspected or confirmed H1N1 influenza, or anyone in close proximity to someone with undiagnosed flu-like symptoms, should wear a fit-tested N95 respirator or greater.
Covering the mouth and nose, the N95 is the most common disposable particulate respirator. It filters at least 95 percent of airborne particles.
CDC cannot mandate the use of N95s but the Occupational Safety and Health Administration can.
Trouble is, there may not be enough N95s to go around this flu season, which the American Nurses Association called "unacceptable" in an Oct. 29 letter to the CDC, and why the American Hospital Association (AHA) wants the federal agency to temper its recommendation with practicality.
Supply Limited
If all hospital personnel who come into even casual contact with actual or suspected H1N1 flu patients wear N95 respirators, "we'll get through winter and run out of them," said James Bentley, PhD, senior vice president for Strategic Policy Planning for the AHA.
"Either we get a surge of flu patients and a diminished workforce to care for them if we're stretching out the masks, or we use them up rapidly and no one has the masks. We want a balanced approach. Use them for people most at risk and allow flexibility for others."
Nurses taking vital signs, for example, or food service workers and housekeepers "will be fine with medical/surgical masks," Bentley said, noting med/surg masks protected Canadian caregivers during the SARS epidemic a few years ago.
A Canadian study published online in the Journal of the American Medical Association Oct. 1 backs up his premise. Researchers at McMaster University randomly assigned surgical masks and respirators to 446 nurses in eight Ontario hospitals as they cared for patients with feverish respiratory illness during the 2008-2009 flu season. It turned out 50 nurses given masks caught the flu as did 48 assigned N95 respirators. "In routine healthcare settings, particularly where the availability of N95 respirators is limited, surgical masks appear to be non-inferior to N95 respirators for protecting healthcare workers against influenza," the authors said.
"Flu is a cool-weather disease," he said. "You would expect it to taper off by next spring. Despite all the publicity, H1N1 so far has followed a variant of the traditional pattern of flu. We have to get to spring and hopefully still have masks for people who really need them."
Conservative Approach
CDC officials, however, are leaning toward a more conservative approach, since recent studies show respirable flu particles are prevalent in emergency departments and hospital treatment areas.
"N95 face pieces provide large and small particle protection beyond what surgical masks provide," said Roland Berry Ann, deputy director of the National Personal Protective Technology Lab at the National Institute for Occupational Safety and Health (NIOSH), the branch of CDC charged with protecting healthcare workers.
What's more, he said, the N95 filtering face piece "is the bottom rung of respiratory protection we certify." Other respirators, such as full-face respirators and powered air purifying respirators with blowers and hoods, offer more protection - for more money.
Asked how many N95s are available as the nation moves into flu season, Berry Ann said NIOSH can only estimate, since many manufacturers use distribution systems that keep no record of their total sales.
"We have received reports of some places finding difficulty getting them when ordered," he said. "Manufactures have reported they are working at full capacity but we recognize there are some local and regional supply problems and inventory problems."
Complicating matters, hospitals tend to shy away from buying unfamiliar-name brands of N95s made in undeveloped countries, especially in these litigious times. "I think people in the health business have gotten skittish of manufacturers in undeveloped countries, where you don't know if the quality control process or the materials used are as good," Bentley said.
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