NEW YORK NURSE: July/August 2009
The article on the H1N1 influenza [“What swine flu has taught us (thus far)”] in the June issue of New York Nurse prompted a number of responses from infection control nurses. They cited guidelines from the New York State Department of Health, which indicated surgical masks were sufficient protection for nurses caring for patients with suspected or confirmed cases of H1N1, unless they were doing high-risk procedures.
NYSNA Occupational Health and Safety Representative Thomas Lowe agrees that nurses should always consult the infection control experts in their facilities if they have questions about the policies and procedures in effect. He also responded to these frequently asked questions:
Surgical masks are designed to provide droplet protection. However, the DOH guidelines state that N-95 respirators should be used for high-risk procedures such as intubation, deep sputum production, or bronchoscopy. These examples are given to guide the practitioner in the right direction, not exclude other care activities that present the same risk. For example, if a patient is actively coughing or sneezing, the nurse is at the same level of risk as one who is performing an intubation.
Federal law (OSHA 29 CFR 1910.134) states that, when deciding which personal protective equipment to use, the employer must first do a credible risk hazard assessment. Simply following DOH guidelines without doing this assessment could be a violation of the federal statute.
As in all influenza cases, there are three modes of transmission: droplet, airborne aerosol, and contact. There is enough evidence to believe that at least some infection is spread by the airborne route, so protection against this mode of transmission should be provided if this risk presents.
According to the Interim Guidance on Planning for Use of Surgical Masks and Respirators in Health Care Settings During an Influenza Pandemic, issued by the Centers for Disease Control and Prevention: “N-95 (or higher) respirators should be worn during medical activities that have a high likelihood of generating infectious respirator aerosols, for which respirators (not surgical masks) offer the most appropriate protection for healthcare personnel.”