Since H1N1 outbreaks surfaced in April, infectious disease doctors, employee health managers, healthcare workers, and infection prevention associations have debated a variety of factors regarding the new virus. But without question the most hotly contended issue has been the use of N95 respirators versus surgical masks for protection.
Meanwhile, many wondered if OSHA would take a side, and it released a clarification supporting CDC guidelines that require N95s for protection against H1N1. Healthcare facilities that do not comply could be cited for serious violations under the General Duty Clause or the Respiratory Protection Standard.
"I think these guidelines tell the players and the referees the rules of engagement," says Marge McFarlane, PhD, MS, CHSP, safety consultant and owner of Superior Performance, LLC. "I look at it as tell me what you expect and I'll see what I can do, rather than you come and say, 'Well you didn't make my expectations.' People don't have time to be a mind reader, so for better or for worse OSHA compliance takes the guessing out of what is expected."
Conduct an exposure risk assessment
Smaller facilities such as outpatient clinics, ambulatory surgery centers, or physician offices may find their procedures don't involve high-risk exposure, or they can initiate other preventative measures to protect staff members.
For example, the first procedure listed on the hierarchy of controls—a list of prioritized infection prevention procedures created by the CDC—is eliminating the hazard of H1N1 whenever possible. Outpatient offices are in a unique position to easily reschedule patients who may have contracted H1N1, reducing exposure to staff and minimizing the need to wear N95s.
"It's really crucial to do a risk assessment because ambulatory care is far, far different from acute care, which is different than long-term care," says Irena B. Kenneley, PhD, APRN-BC, CIC, community health clinical nurse specialist and assistant professor at Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland. "In a risk assessment, you see who is most at risk and what prevention measures can be taken to reduce the risk for each area."
Reusing N95 respirators
One important addition to your respiratory protection plan should be reuse of N95 respirators during a shortage. The OSHA directive indicates that a respirator can be reused as long as it "maintains its structural and functional integrity and the filter material is not physically damaged or soiled."