The Institute of Medicine (IOM) just released the awaited report on the use of masks for health care workers who interact with patients suspected or confirmed to be infected with novel H1N1.  IOM’s report stated that these staff should wear fitted N95 respirators, which filter better than looser medical masks, to help guard against respiratory infection by the virus. The report endorses the current U.S. Centers for Disease Control and Prevention guidelines for respiratory protection against this novel flu virus.  The report went on to say that wearing N95 respirators should be only one element of workers’ and health care organizations’ infection control strategies.

Iom’s Report Stated That Health Care Workers Who Interact With Patients Suspected Or Confirmed To Be Infected With Novel H1N1 Should Wear Fitted N95 Respirators
IOM’s report stated that health care workers who interact with patients suspected or confirmed to be infected with novel H1N1 should wear fitted N95 respirators

While the CDC guidelines and the report’s recommendations are based on the best available information and evidence, scientists do not know to what extent flu viruses spread through the air or whether infection requires physical contact with contaminated fluids or surfaces.  The report calls for a boost in research to answer these questions and to design and develop better protective equipment that would enhance workers’ comfort, safety, and ability to do their jobs.

Singapore Health Emergency Department Staff On Duty In Full Personal Protective Equipment Of N95 Masks, Gowns And Gloves
Singapore Health Emergency Department staff on duty in full personal protective equipment of N95 masks, gowns and gloves

“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, executive vice chancellor for health affairs, University of Texas System, Austin, and former president of the Institute of Medicine.  “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, handwashing, disinfection, gloves, vaccination, and antiviral drug use.”

In the event that the new pandemic virus creates a surge of patients during the upcoming flu season, it will be critical to protect health care workers from infection given their central role in treating sick people and lessening the pandemic’s overall impact.

IOM 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.  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 surgical masks cover the nose and mouth.  Although similar in appearance, surgical masks fit loosely on wearers’ faces, and respirators are designed to form a tight seal against the wearer’s skin.  If properly fitted and worn correctly, N95 respirators filter out at least 95 percent of particles as small as 0.3 micrometers, which is smaller than influenza viruses, the report notes. Rcently released Canadian guidelines call for using N95s only during aerosol-generating procedures and recommend using medical (surgical) masks in other situations, according to the report.

Given the short time frame of this study (the committee has eight weeks to complete its work), the committee was not asked to discuss issues associated with implementing its recommendations, such as costs and supplies, or to assess the impact of other infection control measures, such as vaccination or prophylactic use of antiviral drugs.  However, the committee underscored the importance of using a range of infection control strategies to minimize the chances for exposure and infection for health care workers.

The full report is available for download as a PDF from the IOM website.



If you are flying El Al, you had better not sneeze or cough!  The company as equipped planes with disinfectants and masks and any passengers suspected of infected with the flu will not be allowed on board without medical approval to confirm their health status.

The airline has been prepping to deal with the virus for the past couple of months, briefing its staff and equipping aircrafts with protective measures in case of a suspected sick person on board.  The company plan calls for the suspected passenger to be placed into isolation and the cabin crew will treat the patient with masks, while disinfecting objects that have come in contact with the sick person.

El Al New Policy - Sick With Flu Symptoms, Don't Plan On Flying Anytime Soon!
El Al new policy - sick with flu symptoms? Don't plan on flying anytime soon!

Flight attendants and ground crews have been briefed and trained to detect possible symptoms of the flu according to the International Air Transport Association (IATA) guidelines such as a runny nose, coughing and exhaustion. According to the guidelines, the ground staff will report potentially sick travelers to the airlines’ medical advisor. Suspected passengers will not be allowed to fly without a doctor’s permit confirming they are not sick with the virus.

So far, 19 Israelis have died of the H1N1 virus following pre-existing medical conditions, the latest being an 88-year-old woman who died Monday night in Tel Aviv.  According to estimates, 20 thousand Israelis have contracted the virus, 2,500 of them were detected through lab tests.