Re: Are You Using the Right Mask?

Originally Posted by NurseTink

I work in a 1200 bed, level one trauma, teaching facility. We were told that all influenza A cases this year are turning out to be H1N1 by CDC reports from last week. As of last week we have stopped using a special respiratory isolation and now are using droplet and contact precaution only. Gone are the goggles and n95 masks. We are treating this like any other flu

Thank you, NurseTink.

As of last week, huh? They didn't waste any time. Facilities are no doubt, eager to implement the use of the less costly surgical masks especially since they probably did not have many N95s in stock to begin with.

This seems like a done deal already. Why are they are even bothering to hold these IOM meetings next week?

The next few months are likely to be very difficult for many staff. I work in psych so this is not likely to affect me personally as much. I can't help but think that this is the wrong way to go, and that we do not know enough about what this virus is going to do yet. Add to that, the lack of transparency about fatalities in this country lately. I don't want to say that this is intentional because it may not be. Public health departments are really stretched for funds and staff. They are going to be extremely busy soon as most of you will be as well. The only way we are going to be able to get the big picture of how bad things are is thru govt telling us, (and I have some reservations about how much they are going to be willing to say), what the media says, and our own experience.

Only time, and the stats will tell us if choosing the surgical mask was a wise decision.

Re: Are You Using the Right Mask?

The reason I care so much about fit-testing and associated refresher teaching for N95 users:

"Formal fit testing does not predict future adequacy of fit, unless frequent, routine use is made of the respirator. The utility of fit testing among infrequent users of N95 respirators is questionable."
from

Respirator-fit testing: does it ensure the protection of healthcare workers against respirable particles carrying pathogens?

Infect Control Hosp Epidemiol. 2008 Dec;29(12):1149-56.

Lee MC, Takaya S, Long R, Joffe AM.

PMID: 18980503
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Of course if we all wear n95s 24x7 during this pandemic, we'll fall into the "frequent users" category...until we run out of stock

Re: Are You Using the Right Mask?

http://www.hindustantimes.com/StoryP...e+flu+in+Delhi

But he was wearing a surgical mask!

Of course, he could have been infected at the grocery store, but who did he spend most of his time with...

Originally Posted by www.hindustantimes.com

After a doctor was found infected by H1N1 virus in Pune, three doctors in New Delhi have also tested positive on Friday. According to media reports, these doctors belong to Safdarjung Hospital and CGHS Hospital.

This has happened despite the reports that hospitals are cautious of the infection and are taking all the precautions.

There were reports that all the gate keepers, security men, doctors and even the visiting media personnel were all wearing surgical masks at the hospitals in New Delhi as hundreds of people, from pregnant women to students, flocked to the swine flu testing centre on Friday.

Earlier, on Friday a doctor suffering from swine flu was admitted to the ICU of a hospital in Pune.

The doctor, who works with Inlaks hospital in camp area, has been kept in a ICU in a quarantined ward of the Sassoon General Hospital, according to R R Pardeshi, civic medical officer.

Re: Are You Using the Right Mask?

I do not understand WHY, every time I work, a patient's indicators get CHANGED to contact/droplet.

Routine: A pt is admitted from ER during the night with resp distress or fever of unknown origin. During morning rounds, the attending says, hey, maybe we should do an NP wash. This causes NURSING to say, well, if you're going to do that, they have to go on doplet and be isolated.

(I emphasize NURSING, because it's not policy for NURSING to decide who goes on isolation; this is a physician responsibility, which they, especially interns (which are all new as of July, do not take nearly seriously enough.)

Do these pts turn out to have H1N1?? Yes, as someone else said, pretty much ALL flu is coming back H1N1 now.

This cavalier attitude toward precautions/isolation, causes many HCW's to say, oh, well, I've been taking care of this pt for X amount of time already, too late, no point now.

And we often have no appropriate rooms to put these pts in, anyway, so again, we just say, oh well.

As far as the masks, we use surgical with eye shields now. We did get an email reminding us that eye protection is not optional. Also, pg HCW's are not to be assigned to suspected flu cases. However, as I mentioned previously, the possbility that a pt might have flu comes very late in the game.

It's all very frustrating, and I dread the fall when it will get a billion times worse.

Re: Are You Using the Right Mask?

Originally Posted by indigo girl

I would appreciate it if some others would give the links a read also. My first impression, and I have only skimmed them once, was that this was a choice that they made, and they could just have easily chosen the other option.

Maybe you are right catnip, that it was cost driven. As we continue to track the fatalities especially in HCW, this might prove to be a costly choice, but again, they aren't the ones at the bedside providing care.

On a positive note, the report did say that pregnant staff should be reassigned, but this is not official policy at most facilities yet. How many of you are working in places that are reassigning pregnant staff away from suspected or confirmed cases of swine flu? Mostly I am hearing from pregnant nurses trading with colleagues or individuals volunteering to take those cases to protect pregnant co-workers.

What we do. During the initial few days, when there was a lot of coughing, we stuck to the N95 as I work with predominantly immunosuppressed pts. I am required to mask for all pts anyway. Later, in treatment, I felt more comfortable with using regular surgical mask after the serious amounts of coughing (potential for spraying droplets) had ceased. We also gown and glove.

My issue. People have to remember to trash the mask after each use. No hanging it in the anteroom, no leaving it around your neck but down after use. Given that we mask for everyone, I worry about people with the regular surgical mask forgetting to remove it and using in another pts room. The N95 is heavy ehough - more people remove it than leave it hanging on their neck.

That and the visitors being non-compliant.

We are thus far not assigning pregnant nurses to the room.

Re: Are You Using the Right Mask?

Hi what you tell is akward - hope you are always fine ...
A few comments:
An N95 mask does not filter vapors, only particulates and aerosols. So it can happen you taste the smell of some odours/gases. BUT if you taste during the fit test with approved testing methods the odours, your mask is not right fitted. Which model do you wear ?
In France nobody knows what fit test is - you see the point ! (Tchernobyl clouds did never got the borders of France, you know !).

As for the nurse you saw running out of the room to get the proper protection ... I don't understand if the patient was under respiratory ass with the ventilator? If so, as stated by some tests, everyone being in the room is at risk if not wearing the appropriate mask. Infected particulates are exhausted by the system in the room while the patient breathes on et out, or coughs. She was yet exposed while the patient was not coughing, and more severely when the accident happened.

Re: Are You Using the Right Mask?

"We are thus far not assigning pregnant nurses to the room." quote from post # 24 by caroladybelle

It would be much safer to assign only those without a uterus, or over age 55 to those patients, since CDC thinks older persons may be immune to H1N1; and those without uteri cannpt be pregnant.

That may get some older/senior nurses their jobs back...... or at least job opportunities.

Re: Are You Using the Right Mask?

Since I last posted to this thread there have been some more changes to our battle plan. Our respiratory therapy manager is leading the charge to ensure that any and every person in a room with a suspect H1N1 patient wear full PPE - N95, gown, gloves and goggles. I've decided I'm not going to worry about the fit of my mask. I've been vaccinated and I'm going to wear the mask I was told fits me (8210) and do whatever else I can to keep myself healthy. Now that we've had our first death on the unit, people are taking it all a little more seriously. I just wish our management would restrict visitors...

Re: Are You Using the Right Mask?

What boggles my mind, is that there has been little uniformity of policies for H1N1, as a result of leaders conferring conclusions from their vast resources of knowledge there. They seem to be leaving a lot to individual facilities, as they did the priority policy for those at high risk, in the procedure(s) used by local Health Departments for H1N1 flu vaccine administration, with less than ideal results.

A man told me yesterday, that since he accompanied his children for their vaccinations, the nurse (?) giving the vaccine said although he wasn't in any high risk group, she'd give him the vaccine. too. No wonder they're running out of the stuff before those who are pregnant, caring for infants under 6 months, health care workers, and in the dangerous age range or chronically respiratory impaired!

My understanding regarding the use of proper masks, is that a reliable patient who has H1N1 flu and who hasn't tubes sticking out of their mouths or tracheas (can't get a good fit there), should wear the properly fitted N95 mask when anyone else (including visitors) is present in the room. That catches infective particulates, etc.before they voyage onto another's nose or mouth. When staff or visitors enter the room, both should wear masks, and again if the patient is adequately N95 masked, the other person can wear whatever cheapo mask the hospital sees fit to provide. However, it should be noted that all masks must be changed when sufficient moisture accumulates in either mask, that microorganisms can be propelled faster through the material of the mask they're wearing (that's after sneezing or frequent productive coughing or 10 minutes, whichever comes first).

Now if uncooperative, noncompliant or barely conscious patients are infected with H1N1, the others should wear the N95 masks. Visitors (wearing N95 properly fitted masks - haha) should be restricted to close family and a "significant other", with care taken to allow only 2 visitors in the patient's room at a time, to avoid their visiting each other. That requires supervision, hence a lower ratio of patients:HCWs....... That's if I was the IC nurse at a facility, as I was before becoming undesirably old.

Re: Are You Using the Right Mask?

Our visiting "policy" is such a farce. As it stands, we are supposed to have no more than 2 visitors per patient, limited to parents only after 8 pm, and no one is to visit without a parent present. In reality it's a free-for-all. There are often three or more people at the bedside, any Tom, Dick or Mary who has even a glancing acquaintance with the family, any time they feel like it. In our First Nations communities, everybody is an "auntie", even people who live hundreds of miles away who have the same last name but no blood connection and who can't even give you the child's first name. It's so difficult. They come and go at all hours... and when it's suggested that the middle of the night isn't the best time to visit a critically ill child, you hear, "But we just drove x hundred miles to see my auntie's kid..." We get NO support from our management over restricting these visitors, although they'll stand at the desk gesturing at all the people and glaring at the nurse. So far, the presence of H1N1 on the unit hasn't had any effect on this.