Memorandum

Today the Institute of Medicine (IOM) released its recommendation that health care workers who interact with patients suspected or confirmed to be infected with novel H1N1 influenza A should wear N95 respirators (read the 2-page report brief). IOM emphasized several times throughout its “Letter Report—Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A”   the importance of also utilizing other infection control strategies. 

IOM was asked to evaluate personal protective equipment (PPE) designed to guard against respiratory infection specifically. Therefore, the IOM committee focused solely on the efficacy of medical masks and respirators. IOM did not consider economic and logistical considerations nor did they consider other variables, such as whether healthcare workers are effectively immunized with the H1N1 vaccine.    

IOM found a paucity of studies comparing the clinical effectiveness of respirators versus medical masks in preventing the transmission of influenza viruses. Noting that the need for research is striking, they also recommended an increase in research on influenza transmission and personal respiratory protection. 

The two recommendations are below: 

Recommendation 1: Use Fit-Tested N95 Respirators

Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators or respirators that are demonstrably more effective as one measure in the continuum of safety and infection control efforts to reduce the risk of infection.

• The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.
• Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations, and healthcare workers should use the equipment as required by regulations and employer policies. 

Recommendation 2: Increase Research on Influenza Transmission and Personal Respiratory Protection

CDC centers (e.g., National Institute for Occupational Safety and Health; National Center for Immunization and Respiratory Diseases; National Center for Preparedness, Detection, and Control of Infectious Diseases), the National Institutes of Health, and other relevant federal agencies and private institutions should fund and undertake additional research to

• resolve the unanswered questions regarding the relative contribution of various routes of influenza transmission,
• fully explore the effectiveness of personal respiratory protection technologies in a variety of clinical settings through randomized clinical trials, and
• design and develop the next generation of personal respiratory protection technologies for healthcare workers to enhance safety, comfort, and ability to perform work-related tasks. 

Next Steps

In a CDC briefing on the current H1N1 situation, CDC Director Thomas Frieden stated that the CDC will be studying the IOM report over the next several days.  He noted that the IOM was not charged to look at economics or logistics.

It is AHCA’s understanding that a team made up of various federal agencies, including CDC and OSHA, is in the process of revising the CDC H1N1 Infection Control Guidance.   

AHCA is checking into the availability of N95 respirators, which seem to be in limited supply.  We are working with federal officials and others on this issue and will keep you apprised.  

In the meantime, you may want to check in with your public health departments who likely have N95 respirators in their state strategic stockpile. 

H1N1 Vaccine for Employees Reminder

Facilities that are interested in providing H1N1 vaccine to their employees should contact their local or state public health department immediately.   

H1N1 Contact at AHCA

For the next two weeks while I am out (September 8-18), please direct your H1N1 questions to Steven Gregory at sgregory@ahca.org or 202-898-2849.