Lack of scientific evidence regarding the need for N95 respirators among health care workers has prompted three scientific organizations to urge that OSHA change current recommendations for personal protection from H1N1 flu among health care employees. N95 respirators that require fit-testing are not scientifically proven to be best to protect health care workers from H1N1 flu.
The Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC) have written a letter to President Obama, saying the current guideline recommending fit-tested N95 respirators for health care workers to protect from H1N1 flu could have “dangerous consequences”.
Two recent studies show that surgical masks protect from H1N1 flu as well as N95 respirators. According to APIC 2009 President Christine Nutty, RN, MSN, CIC, “The supply of N95 respirators is rapidly being depleted in our healthcare facilities. We are concerned that there won’t be an adequate supply to protect healthcare workers when TB patients enter the healthcare system.”
Mark Rupp, MD, president of SHEA, says the OSHA guidelines are “deeply flawed”, and are causing confusion among health care employees and hospital administrators.
Comments
This N95 controversy needs debunking. First of all, the above article and similar ones that have been released of late are not one stop shopping for all the information the reader needs, furthermore it appears that this is largely due to sources of “scientists” that have either been mischaracterized or who themselves are trying to obscure not only their own line of reasoning but also their objectives.
Here are the facts:
1.) N95 masks cost more—about $3.50 at a hardware store, so in bulk to a hospital I’d say they are about a buck each (which means that all this wrangling is over $1.00-$4.00 day / employee—at most a $0.50 / hour pay raise to our needy health care workers)
2.) N95 masks are in short supply—who can doubt this
3.) N95 masks REQUIRE OSHA fit testing—what is this? It’s a pain for employers take a look at this OSHA article (as well as employees): w.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9780
4.) Hospital workers need to protect
themselves in order to minimize their risk of contracting H1N1
5.) Other kinds of masks probably will help mitigate some of the risk in contracting H1N1, some more some less (loosely fitting ear-loop masks vs N99 or N100—yes the higher rating means a better job, the yellow coded ones are for dry particulate protection the blue coded ones do better with fumes if you go with 3M)
Now with the facts firmly established one may be able to better define the controversy:
Is the OSHA fitting test too hard? To do it every time one puts on a mask clearly would be un-reasonable. But in my humble opinion to properly train employees to figure out how to use the guidelines to best protect themselves is not unreasonable. Further such guidelines can be borrowed from and applied to masks that are available not just N95 respirators. So if the scientists are saying that in the event of a “shortage” workers should be allowed to make do and use their brains to apply best practices then yes we shou
should be allowed to make do and use their brains to apply best practices then yes we should be all for that—However I seriously doubt anyone is trying to forbid such behavior in the face of a true crisis. But then again OSHA can penalize hospitals for not following guidelines and depending on the situation they may or may not make some kind of concession.
The bottom line should be that OSHA needs to not look first at the hospital or clinic floor for their inspections but rather to look at their procurement schedules to see if they have been keeping up with their required orders—If they have done so and workers are using equipment other than OSHA mandated equipment then no harm no fowl on the part of the institutions or the workers as long as it’s a result of a real shortage.
One final note regarding “evidence”, this is a huge concern with me regarding the medical profession on the whole. Physicians must not be conditioned to throw out all their basic sciences and rely solely
solely on evidence based medicine because simply put all too often it is impossible to fully isolate the variable under study nor eliminate any underlying bias of the researcher. As applied to respirator protection apparatus nothing is going to be perfect but if I do a first principal study based on basic science, get a silicone face strap a bunch of masks on to it and set up a vacuum on the other side of the faces mouth and nose and expose it to particles of various sizes and then grade the masks according to the flux (that is particulate pass through) I can be very confident of the results, on the other hand if I then give the masks to workers and expose them to a virus and check the outcome to “verify” the first principal results, all I could hope for is a positive correlation, however, in no way would the so called “clinical evidence” of “evidence based medicine” ever carry any weight to negate the laws of physics (this is one of the pseudo poly-modal pretexts that (wrongfully) go
TO FOLLOW THE ENTIRE COMMENT PLEASE GO TO THE FIRST COMMENT AT THE BOTTOM OF THIS THREAD AND WORK SEQUENTIALLY UPWARD SORRY FOR THE INCONVIENCE :)
got me into trouble in medical school).
In favor of what can be learned by a clinical study is that if a disease can be contracted by touch alone and not by inhalation then the issue of respirator standards would be a moot point, but truth be told I’d want to put my least porous tissue barrier (skin) up against H1N1, rather than one of my most porous tissue barriers (lung) any day.
quoting einstein, "the comedy has grown tiresome"
Chris - Your thoughts, questions etc. would be great put in front of the IDSA. I'm not sure that three infectious disease societies could share similar objectives, other than...infectious diseases.
Chris,
you are on the right track as others will see. The higher the risks, the more training and protection is required to keep workers safe. Respirator training is pretty simple as is providing respirators to employees once trained. A combo cartridge Vapor/ Particulate is Ideal. And when finally recognizing the hazard as serious, up to and including death, then lets weigh that against training and costs of respirators.
It's always about MONEY VS SAFETY- after enough people die, employers will gladly go this way- I think enough real life research has already been done.
You bring up all the right poinst in your discussion, I thought I would jump in too!
Doug
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