Expert weighs in on H1N1 protection for health workers
Two recent studies, one of which was recently presented at the Infectious Diseases Society of America Annual Meeting, reported that N95 respirators offer no additional protection for health workers from H1N1 flu, compared to surgical masks. In a Lancet commentary, Leonard Mermel, DO, medical director of infection control for Rhode Island Hospital, and past President of Healthcare Epidemiology of America. weighs in on the debate regarding how best to protect health care workers from H1N1 influenza.
Dr. Mermel points to variables that make it difficult to understand spread of H1N1 influenza. "There is ongoing debate regarding influenza transmission and how best to mitigate risk of disease acquisition among health care workers (HCWs). For no other common infectious disease is there such varied opinion, reflecting gaps in our knowledge about a common human pathogen." He adds, "Our limited understanding of such events leaves us vulnerable since we cannot predict which influenza-infected person is a superspreader." – A superspreader is a person who produces high amounts of H1N1 aerosols.
Understanding the best practices to protect health care workers from H1N1 flu encompasses five variables according to Dr. Mermel - We need to better understand the dynamics of H1N1 spread. Other factors involved in protecting health workers from H1N1 flu need to take into account the availability of personal protective equipment (PPE), compliance among health care workers in the use of personal protection, cost of PPE, and existing immunity of health employees.
Important to prevent spread of H1N1 include health care workers staying home when ill, and patients wearing surgical masks as tolerated. Dr. Mermel says, "Science will guide us as we care for patients infected with H1N1 2009 but a lack of attention to our understanding of the transmission of human influenza has left us debating…”
Mermel says use of N95 respirators to protect health care workers from H1N1 flu should be weighed. He suggests, …”use of suboptimum engineered respirators that need fit testing and are poorly tolerated for prolonged use, and limited industrial capacity to meet our needs. For now, infection-control experts at each institution must weigh the variables noted to establish not only what is best, but what is realistic in reducing risk to their staff, their visitors, and their patients."
The debate about how to best protect health care workers from H1N1 flu reflects gaps in knowledge about the disease. Understanding the best practices for protecting health care workers from H1N1 flu, including the use of respirators, requires more information.
Mermel suggests that H1N1 infected patients wear surgical masks as tolerated, and stresses the importance of being realistic about availability, cost, and fit of respirators, such as the N95 respirator to reduce the risk of H1N1 flu spread among health care workers, hospital visitors, and patients. It is also important for health care workers to stay out of the workplace if symptoms of H1N1 flu develop.