HEADLINE: Nurses upset at policy of reusing masks for swine flu protection
SUMMARY: Hospital administrators and nurses are in disagreement on the proper usage of masks in the fight against the H1N1 virus. Because N95 masks are in limited supply, administrators want nurses to use the masks for an entire shift instead of disposing of them after each use.
ANALYSIS: At the request of the CDC and OSHA, the institutes of Medicine (IOM) convened a workshop to examine the issue of “Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A.” That committee’s recommendations stated:
Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators or respirators that are demonstrably more effective as one measure in the continuum of safety and infection control efforts to reduce the risk of infection.
This represents the proverbial “irresistible force meeting the immovable object.” As a union bargaining unit, the California Nurses Association is correct in advocating for its members and promoting safe occupational health practices. Reuse of masks can be complicated by cross-contamination, moisture build-up inside the mask, poor fit and limited airflow potentially resulting in hypoxia. Conversely, if there is a supply shortage and masks are not available, a reasonable plan must be adopted to ensure continued care of patients and protection for those delivering that care. In a 2006 report, the IOM recommended against reusing N95 masks but recognized that reuse may be necessary:
The following steps would allow a person to reuse a disposable N95 respirator if necessary. A protective covering such as a medical mask or a clear plastic face shield should be worn over the respirator to protect it from surface contamination. The respirator should be carefully stored between uses, and the wearer should wash his hands before and after handling it and the device used to shield it. These steps are intended for reuse of a respirator by a single person.Absolutes rarely reflect reality, and this is an example of that condition. It is important to note that these recommendations apply to people in close contact with individuals with H1N1 influenza. That could include non-health workers as well. While reusing masks is to be discouraged, doing so under specific guidelines is superior to having no effective respiratory protection. Each case must be evaluated given the facts at that instance.