Preventing H1N1 Spread to Healthcare Workers: Dilemma and Debate

A commentary in the December 2009 issue of The Lancet Infectious Diseases brings to light the gaps in knowledge on the transmission of a common pathogen – the influenza virus – and its impact on decisions about how best to protect healthcare workers (HCWs).

Infectious diseases specialist Leonard Mermel, DO, medical director of infection control for Rhode Island Hospital, looks at the ongoing debate in light of the H1N1 pandemic, what past research tells us about the spread of influenza, and what is missing in the debate. His commentary is currently available in an online first edition.

Mermel, who is also a professor of medicine at the Warren Alpert Medical School of Brown University and a member of the University Medicine Foundation, says, "There is ongoing debate regarding influenza transmission and how best to mitigate risk of disease acquisition among healthcare workers. For no other common infectious disease is there such varied opinion, reflecting gaps in our knowledge about a common human pathogen."

Mermel points out five variables in preventing the transmission of the virus to HCWs: the dynamics of disease transmission; the availability of personal protective equipment (PPE); compliance among HCWs in the use of PPE; cost of PPE; and immune status of HCWs.

He notes that in two studies, one already published and one recently presented at the Infectious Diseases Society of America annual meeting, researchers found no statistically significant reduction in influenza-like illness among HCWs wearing N95 respirators compared with surgical masks.