IOM recommends N95 respirators and more for health workers

WASHINGTON Healthcare workers who interact with patients suspected or confirmed to be infected with novel H1N1 influenza should wear fitted N95 respirators to help guard against respiratory infection by the virus, according to a new report from the Institute of Medicine released Sept. 3.

The report endorses the current Centers for Disease Control and Prevention guidelines for respiratory protection against the novel flu virus. However, wearing N95 respirators should be only one element of workers’ and healthcare organizations’ infection control strategies, stressed the committee that wrote the report.

While the CDC guidelines and the report’s recommendations are based on the best available information and evidence, scientists do not know to what extent flu viruses spread through the air or whether infection requires physical contact with contaminated fluids or surfaces. The report calls for a boost in research to answer these questions and to design and develop better protective equipment that would enhance workers’ comfort, safety and ability to do their jobs.

“Based on what we currently know about influenza, well-fitted N95 respirators offer healthcare workers the best protection against inhalation of viral particles,” stated committee chair Kenneth Shine, executive vice chancellor for health affairs, University of Texas System and former president of the Institute of Medicine. “But there is a lot we still don’t know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield,” he said. “Healthcare organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, handwashing, disinfection, gloves, vaccination and antiviral drug use.”

In the event that the new pandemic virus creates a surge of patients during the upcoming flu season, it will be critical to protect healthcare workers from infection given their central role in treating sick people and lessening the pandemic’s overall impact, the committee reported.

The Institute of Medicine was asked to evaluate personal protective equipment designed to guard against respiratory infection specifically, and therefore the committee focused on the efficacy of medical masks and respirators. Studies have shown that inhalation of airborne viruses is a likely route of flu infection, supporting the use of respiratory protection during an outbreak even though it is not clear whether airborne transmission is the sole or main way the disease spreads.

N95 respirators and medical masks cover the nose and mouth. Although similar in appearance, medical masks fit loosely on wearers’ faces, and respirators are designed to form a tight seal against the wearer’s skin. If properly fitted and worn correctly, N95 respirators filter out at least 95% of particles as small as 0.3 micrometers (the definition for the N95 rating), which is smaller than influenza viruses, the report noted.

Given the short time frame of this study, the committee was not asked to discuss issues associated with implementing its recommendations, such as costs and supplies, or to assess the impact of other infection control measures, such as vaccination or prophylactic use of antiviral drugs. However, the committee underscored the importance of using a range of infection control strategies to minimize the chances for exposure and infection for healthcare workers.

The study was sponsored by the CDC and Occupational Safety and Health Administration.