CDC: Use of N95 respirators during pandemics is 'prudent' for HCWs
But isolation rooms aren't necessary
Consider this scenario: Pandemic influenza has emerged in the community, there's no vaccine, and antivirals are in short supply. Your stockpile of N95 respirators needs to last as long as possible, because getting a new shipment may be difficult. What do you do?
In its revised guidance on the use of surgical masks and respirators during a pandemic, the Centers for Disease Control and Prevention (CDC) now advises that it is "prudent" for health care workers to use N95 respirators during "direct-care activities involving patients with confirmed or suspected pandemic influenza." It wants health care facilities to plan now to prioritize respirator use.
"Because the interventions available during seasonal influenza are absent during a pandemic, we're calling for this higher level of precautions," says Max Kiefer, MS, CIH, associate director for emergency preparedness with the National Institute for Occupational Safety and Health, which is part of the CDC.
However, the CDC doesn't recommend full airborne precautions with influenza. Isolation rooms are not required for routine patient care, but should be used "when performing high-risk aerosol-generating procedures," the guidance states.
"Strategically, [this] uncouples the use of N95 respirators with having to use a negative pressure room," says Deborah Levy, PhD, MPH, senior advisor for health care preparedness at the CDC in the Division of Healthcare Quality Promotion.
The CDC also recommends the use of other measures to limit staff exposed to influenza, such as segregating patients in a particular ward and designating certain entrances and passageways for influenza patients. Receptionists could be protected by a transparent barrier, notes Kiefer.
With this new guidance, the CDC acknowledges short-range airborne transmission of influenza. (See related article below.)
"With influenza, particularly in the near-range transmission, it's epidemiologically indistinguishable whether [transmission] is droplet or aerosol. The relative contributions of the different modalities are uncertain," says Kiefer.
The question of whether to use surgical masks or respirators with pandemic influenza created controversy and potential confusion. While the Department of Health and Human Services guidance previously called for surgical masks to protect against infectious droplets, some states, such as California and Minnesota, stated that respirators should be used.
"The lack of scientific consensus has led to conflicting recommendations by public health partners," the CDC guidance states. "Moreover, a large amount of incorrect, incomplete, and confusing information about surgical mask and respirator use has been disseminated on the Internet and by other popular media."
In their pandemic planning, hospitals should provide education to health care workers about when and if they will need to wear the respirators, says Levy. Widespread use of respirators among employees who have no direct contact with influenza patients may lead to a shortage — and those who need it most won't have the protection, she says.
Hospitals can include priorities for respirator use in their pandemic plans, but they will need to be flexible, she says. "Until the pandemic arrives, you really don't know what it's going to be like."
(Editor's note: The CDC's Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings is available at www.pandemicflu.gov/plan/maskguidancehc.html#recom.)
How to use N95 respirators safely
In its Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings During an Influenza Pandemic, the Centers for Disease Control and Prevention advises health care workers to be medically cleared, trained, and fit-tested to use N95 filtering-facepiece respirators. They also should take steps to avoid contamination during respirator use:
- Surgical mask or respirator use should not take the place of preventive interventions, such as respiratory etiquette and hand hygiene.
- To offer protection, surgical masks and respirators must be worn correctly and consistently throughout the time they are used.
- Wearing a surgical mask or respirator incorrectly, or removing or disposing of it improperly, could allow contamination of the hands or mucous membranes of the wearer or others, possibly resulting in disease transmission.
Proper surgical mask or respirator use and removal includes the following:
- Prior to putting on a respirator or surgical mask, wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer to reduce the possibility of inadvertent contact between contaminated hands and mucous membranes.
- If worn in the presence of infectious persons, a respirator or surgical mask may become contaminated with infectious material; therefore, avoid touching the outside of the device to help prevent contamination of hands.
- Once worn in the presence of a patient with pandemic influenza, the surgical mask or disposable N95 respirator should be removed and appropriately discarded.
- After the surgical mask or respirator has been removed and discarded, wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer.
- Further information can be found at www.cdc.gov/ncidod/sars/respirators.htm and www.cdc.gov/niosh/npptl/topics/respirators/factsheets/respsars.html#F.
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