What is happening in your hospital? Not using N95 mask, NO screening for H1N1 ,

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I wonder whats really going on these days. Ive got to really wonder whose protecting who when were mandating nurses to take the shots and trying to blame them. How many hospital are not giving the nurses proper equipment and exposing public to H1N1 by not screening. Nurses are required and being told to wear mask and isolation equipment . The public and hospital are demanding we take the shots and stating we need to take the shot because were exposing the public. Recently I receieved a patient headache, difficulty breathing for 3 days, recent exposure to his wife home sick flu, and nausea. No fever. He came to my floor and not tested for H1N1 and no isolation. I called infection control to discuss this with them. Pt was admitted for respiratory distress. Infection control called back and said yes isolate him. I was told on the phone the regular surgical mask on floor were good but we did not need the N95 mask for the flu. I was also told there not testing for H1N1 anymore since it can only acurately screen for 40% of cases. So now were not isolating , not using N95, and I along with many others present have been exposed to this patient (prior to me placing him in isolation). A nursing student told me she was in the city and they were not using N95 on a patient with confirmed case H1N1. They were using regular masks. I even talk to occupational health from another hospital that was giving shots. THey said their hospital is unsure if ok to use mask they got for N1H1 BUT THEY ARE NOT USING THE N95. Wow how much do they really care about nurses? Are we making thing up as we go and to bad for nurses. I would really like to know whats going on in your hospital! Is this common practice? I hear some hospitals are putting nurses at risk demanding they take the shot that are unproven and possibly severe side effect . Its got me wondering how expendable are we? We will not know how many nurses die from H1N1 if they have stopped testing. Our ratios for nurse to patient have increase related to economy and H1N1. How many people know about new panademic rules ? Who gets a ventilator and who does not. If your on and you get so many days someone else can get it. I was told during this debreifing the nurse /patient ratio maybe 30:1. I dont know about the people making the decisions . I know my hospital is definately have alot of family in it. They're all related. I know it takes along time to survive on ventilator if your one of unlucky ones hit hard by it. But I know my charge nurse brags that manager would make sure shes not taken off in 5 days if not better. What are all the nurses seeing out here. The untold facts. How is your hospital dealing with this? Im really confused. Has money and no humanity driven us this far? Maybe we are just a footprint in the sand that is singled out to a meer non existant state . Many of our untold stories , selfless caring acts and being part of the increasing fatalities just doesnt seem to matter .

.:paw: :paw: :paw: :paw: :paw: :paw: :paw:

Specializes in Too many to list.

http://www.bloomberg.com/apps/news?pid=20601202&sid=aGpN0bZcUDbg

Surgical masks didn't stop the spread of flu and other respiratory illnesses during a five-week study involving 1,936 health-care workers at 24 hospitals in Beijing last winter. Thicker versions designed to better fit the face, called N95 masks and made by 3M Co., reduced flu by 75 percent. The N95s cost 5 to 10 times more, said study author Raina MacIntyre, head of public health at the University of New South Wales in Sydney.

"It would not be ethical to recommend surgical masks for health-care workers," MacIntyre said in an interview prior to her presentation. "They have significant leakage around the face. The findings fit everything we know from the experimental data about the poor quality of filtration, the poor fit." MacIntyre presented her findings at an infectious diseases conference in San Francisco.

While the CDC recommends N95 for doctors in contact with pandemic flu patients, many hospitals continue to use the cheaper and more comfortable surgical masks. In today's study, workers in emergency departments received either N95 masks or surgical masks and were asked to wear them throughout their shifts.

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Specializes in Too many to list.
I was told on the phone the regular surgical mask on floor were good but we did not need the N95 mask for the flu. I was also told there not testing for H1N1 anymore since it can only acurately screen for 40% of cases. So now were not isolating , not using N95, and I along with many others present have been exposed to this patient (prior to me placing him in isolation). A nursing student told me she was in the city and they were not using N95 on a patient with confirmed case H1N1. They were using regular masks.

Your facility is not following the CDC guidelines. How they are getting away with this, I don't know.

I suggest copying the guidelines, and asking why them about it. The facilities have been given a legitimate out, and can go into "priority" mode IF they have made a legitimate attempt to procure the N95 masks, and are not able to do so. But, it does not sound like that is what is going on where you are...

Why do you suppose your faciltiy has chosen to throw you under the bus? Are they really in "priority" mode?

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

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

Supply considerations: CDC recognizes that some facilities are currently experiencing shortages of respiratory protection equipment and that further shortages are anticipated. Although the exact total supply in the public and private sectors is not known, a large gap between supply and demand is predicted. In the face of shortages, appropriate selection and use of respiratory protection is critical.2 A key strategy is to use source control, engineering, and administrative measures to reduce the numbers of workers who come in contact with patients who have influenza-like illness in order to reduce the consumption of respiratory protection equipment. For example, combining the use of triage procedures and use of partitions or other engineering controls might reduce exposures and the need for PPE. Other strategies could include taking steps to either reduce consumption of disposable N95 filtering facepiece respirators or extend their use. Some facilities that are experienced in their use may also be able to use alternative PPE for certain applications including more protective filtering facepiece respirators, reusable elastomeric tight-fitting respirators, and reusable powered air-purifying respirators (PAPRs). For facilities that are able to use alternatives such as elastomeric respirators or PAPRs, processes must be in place to ensure that they are used properly and are reliably decontaminated. Additional information about these strategies, including frequently asked questions, are posted on the CDC 2009 H1N1 website (see http://www.cdc.gov/h1n1flu).

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. An example of prioritization for personnel not attending aerosol-generating procedures is shown in Table 2. Prioritization should be adapted to local conditions and should consider intensity and duration of exposure, personal health risk factors for complications of infection, and vaccination status. When in prioritized respirator use mode, respirator use may be temporarily discontinued for employees at lower risk of exposure to 2009 H1N1 influenza or lower risk of complicated infection. Gathering of personal information for the purposes of pandemic planning and response must be done in a fashion that is compliant with all applicable rules and regulations, including the Americans with Disabilities Act (ADA): http://www.eeoc.gov/facts/pandemic_flu.html. Contingency crisis planning is critical to efficient implementation of prioritized use during supply shortages. In making decisions about prioritization, facilities should consider needs for managing patients with diseases other than influenza that require respiratory protection (e.g. tuberculosis) and also considerations related to the timetable for obtaining more respirators. To assure that respirators are likely to be available for the most important uses, facilities should maintain a reserve sufficient to meet the estimated needs for performing aerosol-generating procedures and for managing patients with diseases other than influenza that require respiratory protection until supplies are expected to be replenished.

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.

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Specializes in Too many to list.
So my next question would be, after reading the previous post about the respiratory transmission of the flu, what are we supposed to do about our hospitals not providing the proper protection? My hospital hasn't even fit tested me yet and I have been working there for three months. I have yet to actually see an N95 available in the ER. I can't afford to not work. Makes me think about the questions I might be asking when I go to work tomorrow.

Well, you can copy the links to the CDC guidance to show them, but, if that does not help, you can go on down to your local big box store, think Lowe's or Home Depot, and head to the paint department. They sell the N95 mask there. I have my own as I prefer them to the duck billed variety at my job site, and I keep them in my locker at work. I am not depending on my facility to protect me if they are not staying up to date on this info...

It is best to be fit tested, but I will say that when I listened to Dr. Raina McIntyre's presentation before the IOM about the 24 hospitals in Beijing that participated in her study of the surgical mask versus the N95, she said that the surgical mask was not efficacious in preventing ILI. And, she also said that the N95 whether fit test or not was 75% efficacious in preventing ILI. So, personally, even though I know what size I wear because I have been fit tested, I wouldn't sweat the fit testing...The N95 beats the surgical mask hands down.

http://docs.google.com/gview?a=v&pid=gmail&attid=0.1&thid=12380b820ee09091&mt=application%2Fpdf&pli=1

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Your facility is not following the CDC guidelines. How they are getting away with this, I don't know.

I suggest copying the guidelines, and asking why them about it. The facilities have been given a legitimate out, and can go into "priority" mode IF they have made a legitimate attempt to procure the N95 masks, and are not able to do so. But, it does not sound like that is what is going on where you are...

Why do you suppose your faciltiy has chosen to throw you under the bus? Are they really in "priority" mode?

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

My hospital chose not to follow the CDC guidelines for about 3 weeks, during which time I got the virus. Now, we are using reusable respirators (what a pain!), which I question the purpose of, once one has had the virus/been vaccinated.

I really think they reverted to following the guidelines only because of fear of liability, not because it was the right thing to do.

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I like the idea of just buying your own. I went in to work today and discussed the issue with my manager and she said that if I wanted to wear one, I could. Apparently the Infection Control Nurse is all bent out of shape and is coming to have a talk with me tomorrow about not following the hospital policy, which is surgical masks. I will by all means offer to her that I am happy to buy my own! Thanks for the idea!

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Specializes in Too many to list.
I like the idea of just buying your own. I went in to work today and discussed the issue with my manager and she said that if I wanted to wear one, I could. Apparently the Infection Control Nurse is all bent out of shape and is coming to have a talk with me tomorrow about not following the hospital policy, which is surgical masks. I will by all means offer to her that I am happy to buy my own! Thanks for the idea!

It will be interesting to hear why she is not following the CDC guidelines. Perhaps you should print them out for her and ask if your facility is in priority mode...

In the meantime the latest from the CDC website is this and note the date:

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

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

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Specializes in Acute Care.

We're being encouraged to re-use freaking surgical masks. N95s are a distant memory! Especially now that the H1N1 vaccine rolled out.

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Specializes in Too many to list.
We're being encouraged to re-use freaking surgical masks. N95s are a distant memory! Especially now that the H1N1 vaccine rolled out.

Re-use surgical masks...are they really that poor?

Would you guys even have antibodies to the flu yet?

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Specializes in RN CRRN.

I went back in to work today to our 40ish bed unit and found that each hand sanitizer was removed from all the dispensers and we had a community one at the desk. They had originally said we had to wash our hands more instead (in dirty pts rooms!-you don't know where they have touched and what was on THEIR hands when they dispensed their soap!!! Can anyone say explosive diarrhea etc?). They had first told us it was because Purell couldn't keep up with production, but someone else slipped and said it was because Purell had raised their prices. So let me ask you...do you think the families, before they get on an elevator, not having hand sani-which had been there all along, will go back into a room to wash their hands or stop in a restroom. No they will get on the elevator and push the buttons and touch all the door handles on the way out.....gotta love a pandemic. We are so prepared.

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Specializes in ECMO and CRRT.

At our hospital (a Children's hospital), we are not screening for H1N1 unless the illness is severe (intubated, ECMO, etc). Everyone with respiratory illness gets a rapid flu test, anyone that tests positive for Flu A is on isolation-contact/droplet. A surgical mask is to be worn at all times, an N95 when at risk for droplet exposure (intubations, hand bagging, HFOV). We now have 'new' N95 masks that are white and there is no fit test required (no idea what the name for them is, but I'm humored to know that they are sponsored by NASCAR, and we're in the south)! It's a super pain to sit in a room for 12 hours in full garb b/c the pt is on HFOV, in an isolation room with the door shut. However, everyone is complying b/c we've seen how bad H1N1 can get!!

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Specializes in cardiac, ortho, med surg, oncology.
At our hospital (a Children's hospital), we are not screening for H1N1 unless the illness is severe (intubated, ECMO, etc). Everyone with respiratory illness gets a rapid flu test, anyone that tests positive for Flu A is on isolation-contact/droplet. A surgical mask is to be worn at all times, an N95 when at risk for droplet exposure (intubations, hand bagging, HFOV). We now have 'new' N95 masks that are white and there is no fit test required (no idea what the name for them is, but I'm humored to know that they are sponsored by NASCAR, and we're in the south)! It's a super pain to sit in a room for 12 hours in full garb b/c the pt is on HFOV, in an isolation room with the door shut. However, everyone is complying b/c we've seen how bad H1N1 can get!!

Unfortunately the rapid influenza test is highly in accurate so your patients may be testing negative when in fact they are actually positive. It is my understanding that if they have ILI s/s and test negative on the rapid test they should be treated as suspected H1N1 with appropriate protocols.

Rapid influenza diagnostic tests (RIDTs) are widely available but have variable sensitivity3 (range 10 - 70%) for detecting 2009 H1N1 influenza when compared with real-time reverse transcriptase polymerase chain reaction (rRT-PCR), and a negative RIDT result does not rule out influenza virus infection4 .

Hospitalized patients with suspected influenza should receive immediate empiric antiviral treatment and be tested with an available influenza diagnostic test (Table 1). Identification of influenza infection can improve clinical care and infection control in hospitalized patients. Appropriate antiviral treatment (http://www.cdc.gov/h1n1flu/recommendations.htm) and infection control measures (http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm) should not be delayed pending diagnostic testing results.

http://cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

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Minimal response here at my facility. According to Infection Control regular masks are enough. Plenty of folks test negative on the N95 - myself included - and there are NO Powered Air Purifying Respirator (PAPR) units in the facility.

Regular flu shots have been handed out, the H1N1 vaccine has been started but they were depending on weekly shipments and last week's hadn't come in. No one has come to M-S or Tele to offer the shots yet even though there have been a fair number of ER and Urgent Care clinic people refuse them (first in line over everyone else).

They aren't taking this too seriously. After all we have negative air pressure rooms for isolation - 3 beds out of 140. A few hospitalized cases, yes, but none on vents I am aware of so they don't see this as anything serious here.

I have better PPE at home than we are being supplied with. And I have Tamiflu stocked up as well, for what it's worth. To my knowledge they aren't screening personnel for exposure after confirmation of infection in patients.

Ayrman

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