October 16, 2009

Facemasks Ranked Last In Swine Flu Prevention

New guidelines on protecting health workers against the H1N1 swine flu virus place a greater emphasis on keeping patients away from others than on wearing protective facemasks.

The new recommendations, released Thursday by the U.S. Centers for Disease Control and Prevention, also urged healthcare facilities to vaccinate as many personnel as possible.

"The updated guidance applies uniquely to the special circumstances of the current 2009 H1N1 pandemic and will be updated as necessary as new information becomes available throughout the course of this influenza season," said the agency.

"The updated guidance expands on earlier guidance by emphasizing that successfully preventing transmission requires a comprehensive approach."

The CDC advised that the best way to protect patients and staff from becoming infected is to keep the virus out of the healthcare facility.

"Eliminating the potential source of exposure ranks highest in the hierarchy of controls," the agency said.

Such measures include "taking steps to minimize outpatient visits for patients with mild influenza-like illness who do not have risk factors for complications, postponing elective visits by patients with suspected or confirmed influenza until they are no longer infectious, and denying entry to visitors who are sick."

Personal protective equipment (PPE) ranked lowest in the hierarchy of controls, and is considered a last line of defense for individuals against hazards that cannot otherwise be eliminated or controlled, the CDC said.

"While providing personnel with appropriate PPE and education in its use is important, effectiveness of PPE is dependent on a number of factors. PPE is effective only if used throughout potential exposure periods. PPE will not be effective if adherence is incomplete or when exposures to infectious patients or ill co-workers are unrecognized. In addition, PPE must be used and maintained properly, and must function properly, to be effective."

Engineering controls ranked second in the hierarchy of measures to help prevent the spread of the virus.  

"They are particularly effective because they reduce or eliminate exposures at the source, and many can be implemented without placing primary responsibility of implementation on individual employees."

Such engineering controls include measures such as installing partitions in waiting rooms and using special equipment for airway suction in patients with breathing tubes, both of which can help reduce the spread of the virus, the CDC said.

Administrative controls such as mandatory staff vaccination, keeping sick workers at home, hand hygiene and establishing separate waiting area for patients with flu-like illness can also help, the agency said.

"As a group, they rank third in the hierarchy of controls because their effectiveness is dependent on consistent implementation by management and employees," the CDC said.

PPE ranked last in controlling H1N1 flu in part because it only works well when used correctly and consistently.

"Careful attention to elimination of potential exposures, engineering controls, and administrative controls will reduce the need to rely on PPE, including respirators."

"This is an especially important consideration during the current year, when shortages of respirators have already been reported by many healthcare facilities."

Facemasks known as N95 respirators are considered the best protection against viruses, but are uncomfortable, must be fitted properly and are in short supply.

The CDC urged healthcare workers to get vaccinated against the H1N1 flu. 

In a typical year, just 40 percent of nurses, doctors and technicians are typically immunized against seasonal flu.

"To improve adherence, vaccination should be offered to healthcare personnel free of charge and during working hours. Vaccination campaigns with incentives such as lotteries with prizes should be considered. Healthcare facilities should require personnel who refuse vaccination to complete a declination form," the CDC said.

Generous sick leave policies will also encourage infected workers to stay at home, where they will not risk infecting patients.

The CDC's "Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel" can be viewed at http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm.