Basic Infection Control Measures Backed for H1N1

ACEP News
October 2009

Good hand hygiene and respiratory etiquette are the most important tenets of infection prevention.

BY Heidi Splete
Elsevier Global Medical News

Using basic infection-control practices may be the best approach when caring for patients hospitalized with the pandemic influenza A(H1N1) virus, in contrast to more stringent measures such as the use of respirators, according to a statement from the Society for Healthcare Epidemiology of America endorsed by the Infectious Diseases Society of America and the Association for Professionals in Infection Control and Epidemiology.

The statement, and a joint statement released by SHEA, IDSA, APIC, and the American College of Occupational and Environmental Medicine (ACOEM), departed from current guidance from the Centers for Disease Control and Prevention on protection against pandemic H1N1. The CDC recommendations for pandemic H1N1 differ from those for seasonal flu in two notable ways--by recommending the use of N95 respirators for health care workers, and by recommending the reassignment of health care workers who are not ill but who may be at increased risk.

However, "the current strain of pandemic H1N1 has the same transmission dynamics as seasonal influenza and should be managed as such based on the currently available scientific evidence," said Dr. Lisa Maragakis, an epidemiologist at Johns Hopkins University, Baltimore, in testimony about the statements presented at a recent workshop sponsored by the Institute of Medicine.

"While important, personal protective equipment [PPE] is just one component of a comprehensive program to prevent and control the transmission of infectious organisms such as influenza," Dr. Maragakis said in an interview.

"We must remember that there are many opportunities, both in the community and in health care settings, for infections to be transmitted from infected individuals before they are recognized to be infected," she said.

Regular, thorough hand hygiene and respiratory etiquette (such as coughing into the elbow) are the most important tenets of infection prevention, along with environmental cleaning and disinfection, she added.

PPE is only one layer in a health care worker's protection against the virus, Dr. Toby L. Merlin, deputy director of the CDC's influenza coordination unit, said at the workshop.

"We believe emphatically that PPE is one element in a hierarchy of controls," Dr. Merlin explained.

Current available data and clinical evidence suggest that H1N1 transmission occurs by droplet spread, which would reduce the need for universal use of N95 respirators, the SHEA said in the position statement endorsed by the IDSA and the APIC.

"Surgical masks provide the level of protection needed for health care workers who may be exposed to the H1N1 virus. Using respirators in situations other than when there is the potential for the virus to become aerosolized is not wise," Dr. Anne Gershon, president of the IDSA, said in a statement.

"Respirators do not provide increased protection against the H1N1 virus." 

To access the joint statements, visit shea-online.org.

H1N1 Infection Control Measures

Based on currently available data on pandemic H1N1 transmission, the SHEA, IDSA, and APIC recommend practices similar to those used to prevent the transmission of seasonal flu:

  • Identify patients with suspected pandemic H1N1 as soon as possible.  
  • Place surgical masks on patients with suspected or confirmed pandemic H1N1 as soon as possible.  
  • Place patients with suspected or confirmed pandemic H1N1 in a private room or in a room with other pandemic H1N1 patients.  
  • Adhere to rules of hand hygiene, respiratory hygiene, and cough etiquette.  
  • Follow standard precautions (gown, gloves, mask, and eye protection as needed) when a risk of splash or spray of body fluids is anticipated.  
  • Follow droplet precautions, including wearing a surgical mask when caring for patients with suspected or confirmed pandemic H1N1.  
  • Restrict visitors and health care workers with febrile respiratory illnesses. 
  • Use particulate respirators during certain aerosol-generating procedures, pending additional evidence about the nature of H1N1 transmission.

 Source: Society of Healthcare Epidemiology of America

Leanne Sullivan contributed to this report.

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