Infection Control Specialists: H1N1 Debate is Distracting From Effective Safeguards

Cheryl Clark, for HealthLeaders Media , October 15, 2009

New guidance from the federal Centers for Disease Control and Prevention that all healthcare workers who come in contact with patients suspected of having H1N1 wear N95 respirators is being met with dismay by providers who specialize in infection control.

"Our position was and continues to be that N95s are neither necessary nor practical in protecting healthcare workers and patients against H1N1," says Mark Rupp, MD, president of the Society for Healthcare Epidemiology of America (SHEA).

Not only are the masks ill-suited for this virus, Rupp says, they are in short supply. And if they are used for every provider's contact with a suspected H1N1patient, "they won't be available when they are really needed."

That would be on those occasions when a provider must perform a bronchoscopy, open suction of an airway, CPR, resuscitation or other activities "where there is a much higher risk of aerosol spread."

"It is, quite frankly, a policy that is too broad, too impractical and unnecessary, and will potentially have untoward consequences," he predicts.

What he expects will happen now is that "understandably, some healthcare workers might circumvent the policy by wearing the masks improperly or not at all. Or they might avoid situations where they care for people with H1N1 illness or they may abbreviate their care. The masks are not easy or comfortable to wear for very long periods of time."

Rupp says the policy was influenced by "some folks who are poorly informed or motivated. And some people who are putting pressure through the political system for the CDC to make this decision feel that N95 masks will genuinely offer greater protection. But that doesn't seem to be the case."

Clinical data, Rupp says, shows "no difference between N95 respirators and surgical masks in normal clinical situations."

He says, "Some of the groups that are the most vocal in demanding the use of N95 are the same ones that are vociferously opposed to vaccination. It doesn't add up."

Rupp, of the University of Nebraska Medical Center, emphasizes that health policymakers should focus less on N95 masks and much more on "robust programs that get people who do have symptoms out of the emergency department waiting rooms, get them away from where they can contaminate others."

"We need to be putting in place programs that emphasize the importance of respiratory etiquette, 'Cover Your Cough.' And we need to ask patients who do cough to put on masks to contain secretions, and put policies in place to exclude sick workers and visitors from the hospital."

Unfortunately, he says, "The debate over respirators versus surgical masks has distracted hospitals and clinics from investing in efforts that we know will pay off."

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