3 Sept 2009

3 Sept 2009<= /o:p>

Institute of Medicine= Report Recommends Fit-Tested N-95 Respirators for Healthcare Workers as Respiratory Protection against Pandemic H1N1 Influenz= a

Today the Institu= te of Medicine (IOM) posted online (www.nap.ed= u) a 68-page report titled: “Respiratory Protection for Healthcare Worke= rs in the Workplace against Novel H1N1 Influenza A: a Letter Report”. Their first recommendation was tha= t:

“Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with H1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators or respirators that are demonstrably more effect= ive as one measure in the continuum of safety and infection control efforts to reduce the risk of infection.

&= nbsp; --The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be prov= ided to the effect that other forms of protection or other guidelines are equall= y or more effective.

&= nbsp; --Employees should ensure that the use and fit-testing of N-95 respirators be conducted= in accordance with OSHA regulations, and healthcare workers should use the equipment as required by regulations and employer policies”.

This recommendati= on to use fit-tested N-95 respirators, rather than surgical masks, will prove controversial among some healthcare workers and administrators, in part for= the following reasons cited by the IOM committee:

“It is important to note that controversy exists regarding clinical guideline deci= sion making as many factors besides efficacy may affect policy decisions for PPE guidance including economics, equipment supplies, vaccine availability, immunization status, extent of worker compliance, and logistical considerat= ions in the implementation of such guidance. The committee was not charged to address these issues.”

For hospitals and clinics that decide to follow, as best as possible, the IOM/CDC/OSHA guidan= ce and perform fit-testing for N-95 respirators for healthcare workers during = this time of pandemic H1N1 influenza, the following information from our hospital should be useful. This abstract was presented in 2007 at the “International Meeting on Emerging Diseases and Surveillance (IMED 2007)” in Vienna, Austria by Ella Dade (first author).

As reproduced bel= ow, it provides five (5) practical “lessons learned” from the experience of fit-testing over 5,200 persons working in the largest hospital (907 beds) in Washington, DC, the Washington Hospital Center. The study and the abstract present= ation were strongly supported by Dr. Mark Smith, Director of the Department of Emergency Medicine and EROne Institutes at Washington Hospital= Center, and his colleagues.

N-95 Respirator Fit-Testing of 5,200 Persons in One Hospital over 6 months: Lessons Learned

E.S. Dade, M.S. Smith, D.R. Lucey, C.F. Feied, C= .K. Wuerker, K. Myerson

= Washington Hospital Center, Washington, DC, USA<= /st1:country-region>

Background: Our 907-bed tertiary hospital, the largest in the District of Columbia (DC), decided to offer N-95 respirator fit-testing to all full-time and part-time workers in order to enhance preparedness for SARS, tuberculosis, avian influenza, smallpox, mea= sles, viral hemorrhagic fevers and any other natural or bioterrorist airborne-transmitted disease.  M= ethods: From November 1, 2003 until May 1, 2004 we partnered with a private occupational health company to offer N-95 fit-testing following the standard two-step process. Firs= t, via an optical-mark recognition questionnaire we determined if each partici= pant could be medically cleared. Second, if this clearance was obtained then qualitative N-95 fit-testing was performed. One fit-test technician, testing four persons at= a time, could test a maximum 84 persons/8-hour day. Fit-testing was offered on both day and night shifts, in large central areas and in individual smaller parts of the medical campus. R= esults: 5,377 persons were medically cleared for fit-testing. 5,097 (95%) were able= to be successfully fit-tested with the initial N-95 respirator. An additional 200 failed using the initial respirator but passed the fit-testing using one of two alternative N-95 respirators. Only the remaining 80 (1.5%) persons could not be fit-tested. = ̷= 2;Conclusions: Lessons learned included: (1) by the third month of t= he program a directive from the hospital President was needed to increase participation in the fit-testing program; (2) Detailed information system support was essential to track what became a multi-step process from the distribution of questionnaires to the final documentation of compliance rep= orts to department managers. (3) confidentiality concerns regarding the medical clearance questionnaires were resolved in some cases only by face-to-face interviews with an occupational health nurse; (4) time requirements ranged = from 10-30 minutes for the questionnaire, and 18-35 minutes for fit-testing, including the 'fit-check' demonstration on how to self-monitor the respirat= or seal; (5) easy access to handwashing and drinking water were important to remove the testing solution and decrease the test-failure rate.

Daniel R. Lucey, MD, MPH

EROne Institutes, Department of Emergency Medicine<= /o:p>

Washingt= on Hospital Center

Adjunct Professor of Microbiology and Immunology

Georgeto= wn University Medical Center, Washington, DC

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