The document, titled "Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic," overrides recommendations made in last year's HHS's pandemic influenza plan, which stated surgical masks were appropriate and safe enough to use when taking care of pandemic flu patients.
The new guidance advocates the use of N-95 (or higher) respirator masks for workers engaged in medical activities in which the likelihood of generating infectious respiratory aerosols is high.
In addition, the guidance also dictates that the use of N-95 respirators is "prudent" for health care workers to use when providing other direct patient-care activities such as examinations or feedings.
The guidance also suggests that if N-95 or other types of respirators are not available, surgical masks protect against large-droplet exposure and should be worn around patients with confirmed or suspected pandemic influenza.
But health care facilities are advised to expect and plan for N-95 shortages and similar protective equipment in the event of a pandemic.
Kiefer: Respirators Shouldn't Replace Prevention
During the Second Annual Emergency Preparedness Conference in Washington, D.C., Max Kiefer, associate director for emergency preparedness and response with the National Institute for Occupational Safety and Health (NIOSH), emphasized that while having an adequate supply of respirators and other equipment is essential for the safety of health care workers and others who come into contact with influenza patients, they should not replace preventative measures.
"Respirator or surgical mask use should not take the place of appropriate infection control and prevention interventions," he explained. "Measures such as good hand hygiene and the use of gowns, and eye protection, should continuously be followed."
CDC Addresses Concerns on Lack of Definitive Data
Kiefer said that the Centers for Disease Control and Prevention (CDC) received many comments on its November 2005 influenza plan, which addressed concerns on the lack of definitive data about short-range airborne transmission as well as on the limited information on optimal interventions and their individual effectiveness.
The new guidance states that the CDC "is aware of no new scientific information related to the transmission of influenza viruses since the drafting of the HHS Pandemic Influenza Plan" and that the "proportional contribution and clinical importance of the possible modes of transmission of influenza (i.e. droplet, airborne and contact) remains unclear and may depend on the strain of virus ultimately responsible for a pandemic."
However, because of the practical need for clarification, CDC stated that it reviewed the data again and has prepared recommendations on respirator and surgical mask use for the purpose of providing a "science-based framework to facilitate planning for surgical masks and respirator use in health care settings."