CDC Updates Infection Control Guidance for Swine Flu

[indigo girl]

http://afludiary.blogspot.com/2009/10/cdc-updates-infection-control-guidance.html

I only posted some of what is on the link.

Follow the link to read it in its entirety:

Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel

October 14, 2009, 2:00 PM ET

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

Symptoms of Influenza and Viral Shedding

The symptoms of influenza, including 2009 H1N1 influenza, can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, nausea, diarrhea, and vomiting. Depending on the case series, the proportion of persons who have laboratory confirmed 2009 H1N1 infection and do not have fever can range from about 10 to 50%.

2009 H1N1 influenza virus appears to be transmitted from person to person through close contact in ways similar to other influenza viruses. Although the relative contribution of each mode is uncertain, influenza virus can potentially be transmitted through:

Droplet exposure of mucosal surfaces (e.g., nose, mouth, and eyes) by respiratory secretions from coughing or sneezing;

Contact, usually of hands, with an infectious patient or fomite (a surface that is contaminated with secretions) followed by self-inoculation of virus onto mucosal surfaces such as those of the nose, mouth, and eyes; and

Small particle aerosols in the vicinity of the infectious individual.

Transmission of influenza through the air over longer distances, such as from one patient room to another, is thought not to occur. All respiratory secretions and bodily fluids, including diarrheal stools, of patients with 2009 H1N1 influenza are considered to be potentially infectious.

Respiratory Protection –

Recommendation: CDC continues to recommend the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza. This recommendation applies uniquely to the special circumstances of the current 2009 H1N1 pandemic during the fall and winter of 2009-2010 and CDC will continue to revisit its guidance as new information becomes available, within this season if necessary

[RedWeasel, RN]

Sorry does that mean no more surgical masks? Because that would make me feel better...

[indigo girl]

Sorry does that mean no more surgical masks? Because that would make me feel better...

Au contraire, ma soeur! No, but the hospitals now feel better...

They have just been given permission to give you the surgical mask if they run out of N95. They pushed very hard to get the CDC to change the guidance away from the N95, but they did not entirely succeed...

The hospitals say they don't have enough N95. But, is this true?

One of the mask providers, the 3M Company consistently has said at the open IOM hearings on PPE in Washington, and at the recent CIDRAP Conference where I talked to them personally that there is no shortage of these masks. Just "telll us what you want, and we will get it for you!"

There seems to be a disconnect somewhere...

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

Personal protective equipment (PPE): PPE ranks lowest in the hierarchy of controls. It is a last line of defense for individuals against hazards that cannot otherwise be eliminated or controlled....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.

Prioritized respirator use: Where a shortage of respirators exists despite reasonable efforts to obtain and maintain a sufficient supply for anticipated needs, in particular for very high exposure risk situations such as some aerosol-generating procedures (listed below), a facility should consider shifting to a prioritized respirator use mode. In this mode, respirator use is prioritized to ensure availability for healthcare personnel at most risk from 2009 H1N1 influenza exposure. Even under conditions of prioritized use, personnel attending aerosol-generating procedures on patients with suspected or confirmed 2009 H1N1 influenza should always use respiratory protection at least as protective as fitted N95 respirators.

Facemasks for healthcare personnel who are not provided a respirator due to the implementation of prioritized respirator use: If a facility is in prioritized respirator use mode and unable to provide respirators to healthcare personnel who provide care to suspected and confirmed 2009 H1N1 influenza cases, the facility should provide those personnel with facemasks. Facemasks that have been cleared for marketing by the U.S. Food and Drug Administration have been tested for their ability to resist blood and body fluids, and generally provide a physical barrier to droplets that are expelled directly at the user. Although they do not filter small particles from the air and they allow leakage around the mask, they are a barrier to splashes, droplet sprays, and autoinoculation of influenza virus from the hands to the nose and mouth. Thus, they should be chosen over no protection. Routine chemoprophylaxis is not recommended for personnel wearing facemasks during the care of patients with suspected or confirmed 2009 H1N1 influenza.

http://www.cdc.gov/H1N1flu/guidance/control_measures_qa.htm

CDC recognizes current and anticipated shortages; therefore, the guidance also provides for healthcare facilities to develop a risk assessment by which respirators in critically short supply can be issued on a priority basis.

Q. Will there be enough N95 respirators to meet the anticipated demand?

Some healthcare facilities are experiencing shortages of respiratory protection equipment, and further shortages are anticipated. Therefore, appropriate selection and judicious use of respiratory protection is critical. A key strategy is to use recommended administrative measures to reduce the number of workers who come into contact with patients who have influenza-like illness.

[lamazeteacher]

".........influenza virus can potentially be transmitted through:

Droplet exposure of mucosal surfaces (e.g., nose, mouth, and eyes) by respiratory secretions from coughing or sneezing;........" quote from indigogirl's OP

What part of the above indicates a decreased need for droplet/respiratory isolation?

The fact that N95 respirator masks have been in use throughout the endemic, should have inspired increased production of same (which has happened).

Knowing the intellect of the Departments that purchase such items, I can imagine the peruser of catalogues for N95s saying to themselves and/or others, "This is expensive, and it's not a mask, it's a respirator!" "It can't be what they want, I'll just get the surgical masks." "They want something that tastes bitter, too? What's going on with that?"

So I usually looked up the items I needed for Infection Control when I worked in that capacity, and ordered them using the number in the catalogue that supplied them and how many were required (a very high # ). When they received my order, a kneejerk response sent those buyers (a misnomer, they hate to buy) directly to administration in protest. I'd meet them at the entrance to administration with my prepared documentation. When that happens, there's no shortage of N95s.

[Leanne62499]

Well...this guidance just gives hospitals more power to say no to the N95 mask...in fact I just had a patient this week, with confirmed H1N!, and I was told to use just a regular mask...I still got the N95 tough!

[indigo girl]

Well...this guidance just gives hospitals more power to say no to the N95 mask...in fact I just had a patient this week, with confirmed H1N!, and I was told to use just a regular mask...I still got the N95 tough!

Good for you!. I would go on down to the paint department in the Big Box stores, and buy my own N95 just in case...Don't want the hospital shortage to be my problem.

[RedWeasel, RN]

ya I thought a few years ago our govt 'prepared' for a pandemic when the threat of bird flu loomed. I guess there is no stockpile available from the govt to protect the frontline people from taking it home and spreading it to family. Makes you wonder what else they don't have available if they have no masks. And they want us to come to work in a pandemic situation? The early threads on this H1N1 most nurses said, "No PPE, No workee." Guess we have to protect ourselves. I think I will get some from the drug store.

[katgal]

At our hospital we are having to wear PAPRs - large helmets with multiple filters and air pumped through into the mask. We had our first H1N1 case last night - a 7 y/o boy. I bet this poor kid has nightmares for the rest of his life due to the "space men" that kept coming into his hospital room. I think this is overkill, it may be appropriate for a TB case but from what I have read on the CDC website an N95 mask is sufficient. Is anyone else's facility using these?

[indigo girl]

At our hospital we are having to wear PAPRs - large helmets with multiple filters and air pumped through into the mask. We had our first H1N1 case last night - a 7 y/o boy. I bet this poor kid has nightmares for the rest of his life due to the "space men" that kept coming into his hospital room. I think this is overkill, it may be appropriate for a TB case but from what I have read on the CDC website an N95 mask is sufficient. Is anyone else's facility using these?

No, we are wearing the duck billed, N95 which looks scarey enough, and is rather uncomfortable. PAPRs are supposed to be better for pregnant women, but then they really should not be taking care of swine flu patients in the first place, imho.

For people who cannot wear the N95 because of poor fit due to whatever reason such as having a beard etc., then PAPRs are the way to go. It does seem rather expensive and over the top for most of us though.

[nurse_mo1986]

My hospital in the midwest is being over-run with cases of H1N1. We're all going the N95 route as per our infection control team. We all took mandated vaccines yesterday. Only ppl using the PAPR are those who can't fit the N95 mask, or are prego.