Industrial hygiene group says N95s the right call

The American Industrial Hygiene Association (AIHA) has issued a position statement on H1N1 pandemic influenza A that endorses and reiterates the key findings of an Institute of Medicine panel that recommended N95 respirators for health care workers. Key points stressed by AIHA include:

• H1N1 and seasonal influenza are spread by the airborne route and not limited to "droplet" or contact spread.

• A current H1N1 infectious dose has not been established. This could vary for every organism, disease, and microbial strain; therefore, it is not effective to stratify protective measures.

• Health care workers are at increased risk of H1N1 infections. Health care organizations and workers need consistent and clear H1N1 guidelines that can be implemented across all health care facilities. In addition, employers must devote significant effort to assessing risk in their organizations and to fully implement those guidelines so needed practices are widely adopted. This should include ongoing education and training of health care workers.

• Respiratory protection is one component of an effective aerosolized transmissible disease program. Other components include appropriate administrative and engineering controls (i.e., triage, cohorting of patients, prompt identification, isolation, signage, patient masking in public or semipublic areas, covering cough and sneezes, hygienic practices, education, ventilation).

• Health care workers (including those in nonhospital settings) who are in close contact with individuals with H1N1 influenza or influenza-like illnesses should be provided with fit-tested N95 respirators or other respirators that are demonstrably more effective. This is one measure in the continuum of safety and infection control efforts to reduce the risk of infection. Employers should ensure the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations, and health care workers should use the equipment as required by regulations and employer policies. An effective respiratory protection program must include medical surveillance, fit testing, and training as described in the NIOSH and OSHA documents and standards.

• Adequate respiratory protection is not provided by "surgical masks," including most devices approved by the Food and Drug Administration.