Protecting health care personnel from influenza

Health care facilities, including hospitals, nursing homes, physicians' offices, urgent-care centers and home health care providers, are always concerned about potential airborne transmission of influenza. The potential for exposure to viruses is much greater for health care workers because influenza viruses can be spread through direct contact with small particle aerosols passed through the air when an infected person coughs or sneezes. Traditionally, health care personnel use surgical masks for protection, but to properly protect against airborne transmissions when in close proximity to an infected person, NIOSH-approved respiratory protection should be worn by all medical workers who are susceptible to exposure.

Many people are unaware that surgical masks are not approved by NIOSH and do not provide proper respiratory protection for health care personnel. Only NIOSH-approved respirators provide suitable respiratory protection from airborne transmission of small particle aerosols. The most common respiratory solutions for health care personnel during a pandemic are NIOSH-approved disposable filtering facepieces and elastomeric air-purifying respirators. Elastomeric, half-facepiece air-purifying respirators offer specific advantages versus disposable filtering facepieces in pandemic scenarios, such as increased durability.

In higher-risk activities, there is increased opportunity for exposure of the health care worker to the expelled particle droplets. The Centers for Disease Control and Prevention specifically recommends disposal of N95 respirators after performing aerosol-generating procedures or if the N95 is contaminated with patient blood, secretions or other bodily fluids. Following specific guidelines from CDC and OSHA will help optimize any respiratory protection program.

CDC defines "re-use" of a respirator as, "where the respirator is removed and re-donned between patient encounters" by the same user. CDC refers to "extended use" of a respirator when a user is "wearing over multiple encounters while minimizing touching, removing or re-donning between encounters." Both practices will increase the useful life of your existing supply of respirators.

OSHA 1910.134 defines respiratory protection program requirements. Within the standard, there are guidelines for inspecting, cleaning and disinfecting. The respirator must be visually inspected prior to and following each use.

Here are four guideline categories to define procedures:

1. Respirators issued for the exclusive use of an employee should be cleaned and disinfected as often as necessary to be maintained in a sanitary condition.
2. Respirators issued to more than one employee should be cleaned and disinfected before being worn by different individuals.
3. Respirators maintained for emergency use should be cleaned and disinfected after each use.
4. Respirators used in fit testing and training should be cleaned and disinfected after each use.

For the purpose of "re-use" and "extended use" of respirators during a pandemic by a single individual, the respirator would require inspecting, cleaning and disinfecting as necessary.