Protecting workers said 'integral' to quality care
OSHA rule, respirator design supported
The H1N1 influenza pandemic might prompt lasting changes in the personal protective equipment for healthcare workers and the rules that govern them.
In the wake of the pandemic, a new report from the Institute of Medicine (IOM) supports the creation of an infectious disease standard with protections that parallel those in the Bloodborne Pathogens Standard. The Occupational Safety and Health Administration (OSHA) has included such a standard in its regulatory agenda, although no draft language has been issued.
The IOM panel also supports the establishment of standard criteria for facemasks and the development of a powered air-purifying respirator (PAPR) specifically for healthcare.
Although the report is primarily designed to guide future research, it wades into issues that have been hotly debated and urges that they not be sidelined until the next pandemic. Healthcare providers need clear guidelines about how to protect workers from a novel viral respiratory infection, and there needs to be more research on the protections provided by facemasks compared to respirators, the panel said. The bottom line: "While there are clear gaps and deficiencies in our knowledge base...there should be universal acknowledgement that PPE [personal protective equipment] use is an integral component of providing quality health care."
The IOM report is an important step toward a respirator that healthcare workers will tolerate and wear, says Lewis J. Radonovich, MD, director of the National Center for Occupational Health and Infection Control in the Office of Public Health and Environmental Hazards of the Veterans Health Administration in Gainesville, FL, and Washington, DC. "What's needed now is development of respiratory protection devices that are tailored to the needs of healthcare workers," says Radonovich, who is spearheading a project to work with manufacturers on improved design.
Confusion over H1N1 guidance
From supply shortages to differing guidance, challenges emerged for facilities in the effort to protect healthcare workers from the novel influenza virus.
The Centers for Disease Control and Prevention (CDC) advised using N95 respirators when caring for patients with the novel influenza, but some state or local health departments recommended using facemasks unless performing aerosol-generating procedures. "Delayed and/or disparate recommendations often led to confusion among health care personnel and their employers, who had to decide what to tell personnel about what type of PPE to wear and when," the IOM panel said.
The result was that healthcare workers in different parts of the country or at different facilities received different levels of protection from the H1N1 influenza. "During the 2009 H1N1 pandemic, the California standard was the only workplace standard in the United States that required a mandatory level of worker protection to be provided to health care personnel," the panel said.
Bill Kajola, industrial hygienist with the AFL-CIO in Washington, DC, and a member of the IOM panel, says, "What we found was wide variation in the use of personal protective equipment during the H1N1 pandemic. Some employers adhered to the CDC and OSHA guidelines in their entirety; other employers followed some of the recommendations; and other employers did very little." An infectious diseases standard "is a means to put everybody on the same level playing field as far as the protections that all healthcare workers should expect," he says. (Editor's note: The IOM report, "Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel Update 2010," is available for free download at www.nap.edu/catalog.php?record_id=13027.)
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