U.S. medical body joins call for N95 respirators

NUPGE has already asked the Public Health Agency of Canada to issue 'fit-tested NIOSH approved N95 respirators' to all health care workers exposed to the H1N1 flu virus.

Ottawa (8 Sept. 2009) - The U.S. Institute of Medicine (USIM) is now calling for all health care workers exposed to patients with the H1N1 flu virus to be issued N95 respirators, echoing a call already made for health care workers in Canada by the National Union of Public and General Employees (NUPGE).

Health care workers who interact with patients suspected or confirmed to be infected with H1N1 influenza A – the new strain of pandemic flu – should wear fitted N95 respirators, the institute says in a new report issued in Washington.

N95 respirators filter the air better than looser medical masks and provide greater protection against respiratory infection, it says.

The report endorses current guidelines from the U.S. Centers for Disease Control and Prevention (CDC) for respiratory protection against the H1N1 virus, also commonly referred to as swine flu.

James Clancy letter

In Canada, NUPGE president James Clancy wrote a letter to the Public Health Agency of Canada (PHAC) recommending that "fit-tested NIOSH approved N95 respirators" be made available to all health care staff who come in contact with the virus.

James Clancy, president of the National Union of Public and General Employees (NUPGE) Health care workers account for more than 100,000 of NUPGE's 340,000 members across Canada. They include 70,000 health sciences professionals who deliver diagnostic, clinical, rehabilitation and preventive services.

Clancy called for changes in Annex F of the agency's Canadian Pandemic Influenza Plan (CPIP) to deal with the situation.

"In our view Annex F does not go far enough to protect health care workers in the event of a pandemic influenza outbreak such as the H1N1 virus," he wrote.

"More specifically we are concerned that Annex F does not adopt the precautionary principle and does not recommend that, as a minimum standard, all health care workers having direct patient contact with either suspected or confirmed cases of a pandemic influenza virus be provided with a fit-tested NIOSH approved N95 respirator."

Respirators alone not enough

In Washington, the USIM report said N95 respirators should only be one element of workers' and health care organizations' infection control strategies.

"Based on what we currently know about influenza, well-fitted N95 respirators offer health care workers the best protection against inhalation of viral particles," said committee chair Kenneth Shine, a former USIM president.

"But there is a lot we still don't know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield. Health care organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, hand washing, disinfection, gloves, vaccination, and antiviral drug use."

The Institute of Medicine was asked to evaluate personal protective equipment designed to guard against respiratory infection specifically, and therefore the committee focused on the efficacy of medical masks and respirators.

N95s filter tiny particles

Studies have shown that inhalation of airborne viruses is a likely route of flu infection, supporting the use of respiratory protection during an outbreak even though it is not clear whether airborne transmission is the sole or main way the disease spreads.

N95 respirators and medical masks cover the nose and mouth. Although similar in appearance, medical masks fit loosely while respirators are designed to form a tight seal against the skin. If properly fitted and worn correctly, N95 respirators filter out at least 95% of particles as small as 0.3 micrometers, smaller than influenza viruses, the report notes.

The study was sponsored by the CDC and Occupational Safety and Health Administration. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector and the public.

NUPGE

The National Union of Public and General Employees (NUPGE) is one of Canada's largest labour organizations with over 340,000 members. Our mission is to improve the lives of working families and to build a stronger Canada by ensuring our common wealth is used for the common good. NUPGE

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