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The California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) says it applauds the Institute of Medicine (IOM) for recommending strong protections for patients and caregivers to avoid airborne transmission during the H1N1 flu pandemic, and calls on the Centers for Disease Control and Prevention (CDC) to meet the same stringent standards.
"America's registered nurses have significant experience dealing with H1N1 flu, and we know that we need the highest level of safety protection for patients and nurses alike, including the N95 masks," said Deborah Burger, RN, co-president of CNA/NNOC. "We've seen infection clusters caused by inadequate safety gear, and hospitals cutting corners on their preparedness for the virus. We need to ensure that any guidelines improve patient care and safety in hospitals -- not weaken it.”
Last Tuesday the Institute of Medicine (IOM) issued a report, "Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A," reviewing all available scientific literature, and concluding that the evidence on transmission makes clear that nurses and other caregivers caring for H1N1 and suspected H1N1 patients should use NIOSH-certified respirator masks of N95 or better that have been tested to ensure proper fit. They specifically argued that: “...the committee noted that in the recent outbreak of H1N1 in Mexico, strict adherence of infection control measures including the use of N95 respirators prevented healthcare workers from contracting influenza-like illness...One study that has been submitted for publication compared the clinical efficacy of medical [surgical] masks versus N95 respirators in healthcare workers and found that N95s had statistically significant efficacy while medical masks showed no efficacy...”
On the heels of the IOM recommendations, the CDC held a conference call with healthcare organizations questioning much of the report, leading many nurse and caregiver organizations to fear that the IOM recommendations would be replaced with weaker standards not borne out by the scientific evidence.
The IOM recommendations come after a recent survey sponsored by CNA/NNOC of 190 American hospitals that found wide gaps in H1N1 preparedness. Nurses at 15 percent of hospitals report they do not have access to the proper respirator masks, exposing nurses and patients to infection; at up to 40 percent of the hospitals, nurses are expected to reuse masks, in violation of Centers for Disease Control guidelines and IOM recommendations. In addition, at more than one-fourth of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.