Infection Control for Pandemic FAQ

Answers to questions posed at the May 2006 pandemic plan preview meetings.
Posted: 7/12/06

How many respirators have been purchased with HRSA funds and are cached in the various regions? 

Persons involved in pandemic planning activities can request this information for their region.  To obtain that information, contact your Bioterrorism Hospital Preparedness Program (HRSA) Regional Hospital Resource Center Coordinator. 

Will the state take a position that emergency managers and first responders should be provided protection (prophylaxis or PPE) before the general public?

Personal Protective Equipment (PPE) should be prioritized to persons who are most at risk of exposure/infection.  Healthcare workers providing direct care to infectious patients would be at the most risk and should be prioritized for PPE.  It is unlikely that emergency managers would be providing direct patient care so they would most likely not have a need for PPE.  The category of people classified as “first responders” is broad category and again, the risk of exposure should be determined and PPE should be prioritized to those at greatest risk of exposure.  For example, fire and police could potentially be first responders to a home where an infectious person is extremely ill.  In this situation, these first responders should have PPE.  However, providing patient care is not something that is a regular part of their job duties (as it would be for EMS personnel), therefore, these agencies should not need as much PPE on hand as healthcare facilities and EMS agencies.

Vaccine and antiviral prophylaxis, if available, would also be prioritized on the risk of exposure.

When will MDH come out with PPE recommendations for public safety personnel?

These recommendations are already posted on the MDH website at:. 

Public safety personnel (e.g. fire and police) who are likely to respond to health emergencies or who might be called upon to enforce isolation/quarantine orders for potentially infectious people should be fit tested and should be provided PPE, including N95 respirators when performing such duties.  However, because patient care is not the primary responsibility of public safety personnel, it is reasonable to fit test only a portion of such personnel.
MDH, in partnership with several State agencies and public safety professional organizations, developed a video training course to provide public safety personnel with basic information on infection control for communicable diseases.  This course, "Public Safety Preparedness in the Age of Bioterrorism, SARS, and Other Emerging Health Threats," consists of four 15-minute videos.  The videos are:

  • Part 1:  Isolation and Quarantine under Minnesota Statutes
  • Part 2:  Infectious Disease Basics
  • Part 3:  Infection Control for Public Safety Personnel:  Standard Precautions and Bloodborne Pathogens
  • Part 4:  Infection Control for Public Safety Personnel:  Expanded Precautions

While the video series addresses SARS, the infection control recommendations described apply to avian and pandemic influenza since the routes of transmission are the same. The videos have been distributed to local public health and public safety professional organizations.

Does the Minnesota Department of Health have specific instructions for healthcare facilities to follow (i.e. limit visitors, secure facility, etc.) in event of human-to-human transmission and if so where might this information be located?

The infection control guidance MDH has provided to healthcare facilities includes a recommendation to limit the number of healthcare workers and visitors who have direct contact with patients who are known or suspected to be infected with avian or pandemic influenza. This strategy will be essential not only to decrease the number of staff potentially exposed, but also to promote the judicious use of PPE supplies. 

Would you suggest that clinics be prepared with N95 respirators for frontline employees? What criteria were used for your decision?

Yes. MDH recommends “Full Barrier” precautions (airborne and contact precautions plus eye protection in addition to standard precautions) for all known or suspect cases of avian or pandemic influenza. The rationale for these recommendations is based upon an understanding of respiratory aerosols and their transmission and the recognition that the airborne route is one of the possible modes of transmission of influenza.  Pandemic influenza patients are likely to seek care in an ambulatory care setting, there fore, it is prudent for ambulatory care clinics to fit test a number of healthcare workers who provide direct care for patients and to have access to appropriate PPE for these workers.

In following full barrier precautions, N95 respirators or powered air-purifying respirators (PAPRs) should be worn by staff providing direct care to patients who are known or suspected to be infected with avian or pandemic influenza, regardless of the healthcare setting in which they work.  A medical evaluation must be done and N95 respirators must be fit tested prior to first use. 

Surgical masks do not protect the wearer from inhaling respiratory aerosols generated from ill patients.  However, surgical or procedure masks can help to contain the respiratory secretions of ill patients and ill patients should be asked to wear a surgical mask, if it can be tolerated. 

Is the state stockpiling N95 respirators?  They are one-time use items.  What other protection or alternate protection is available/suggested?

MDH is acquiring a small stockpile of N95 respirators and other personal protective equipment (PPE). Additionally, each Minnesota HRSA region has a PPE cache. Check with your Regional Hospital Resource Center Coordinator (RHRC) to see what has been done in your region.

Most N95 respirators are disposable.  However, when used in the care of TB patients they may be reused by the same healthcare worker (HCW) until they are damaged, soiled, or difficult to breathe through because TB is not spread by contact.  However, influenza virus is spread by contact, in addition to respiratory aerosols.  Therefore, when worn in the care of a pandemic influenza patient, the outside surface of the respirator could become contaminated with respiratory secretions.  If the respirator were reused, HCWs could contaminate their hands when handling the respirator and possibly inoculate their eyes, nose, or mouth with the virus.  This is why reuse is not recommended in the care of SARS (which is also spread by respiratory aerosols and contact) or pandemic influenza patients.  However, in a pandemic, it is likely that there will be a shortage of all PPE, including respirators, and that reuse will be necessary.  Methods of reuse are being explored, and reuse recommendations will be posted on the MDH website as they become available.   

There are many types of respirators and any NIOSH-certified respirator at least as protective as an N95 respirator may be used.  Powered air-purifying respirators (PAPRs) are an alternative to N95 respirators and are comfortable to wear, offer a higher level of protection than N95 respirators, and do not need to be fit tested.  However, they are costly, require appropriate disinfection after use and on-going maintenance to assure proper functioning.

If no other respiratory protection is available, a tight fitting surgical mask may be used, but it should be understood that surgical masks will offer significantly less protection to the wearer than a respirator.

While we continue to stockpile N95 respirators to help protect our workers, we will never have enough if the current guidance of one mask per patient contact.  Are there studies on how effective UV light is for decontamination of N95 respirators?

There are currently no studies on the efficacy of UVGI to decontaminate N95 respirators.  In early 2006, the Institute of Medicine (IOM) convened a group to explore options for reuse of N95 respirators during a pandemic.  This group concluded that little is known at this time about the effectiveness of cleaning/disinfection methods or the performance of N95 respirators after cleaning/disinfecting. Additional research is needed and NIOSH is currently evaluating proposals for research in this area.  It is likely that recommendations for reuse of respirators would be made during a pandemic.    

Should local public health be stockpiling N95 respirators? What kind of PPE is needed by local public health staff?

LPH agencies are encouraged to work closely with their regional HRSA planners to determine the need for stockpiling. To determine the possible need for PPE,  LPH should consider what role/s their staff might play during a pandemic. LPH staff who might reasonably be expected to have direct contact with infectious persons (e.g., staff who may make home visits to infectious patients to provide care) should be fit tested and agencies should have access to PPE, including respirators, for these persons.  PPE recommendations would be the same as for other HCWs in direct contact with infectious patients. Respirators would not be typically used at mass vaccination clinics, other than possibly for personnel working with ill people who have been triaged at entry.

How much PPE should each region/local be stockpiling? N95 respirators, gloves, gowns, protective eyewear for public health; for home care departments in a public health office? How many supplies per staff?

The rationale behind stockpiling respirators and other PPE is that hospital and clinic supplies of PPE for direct care providers are likely to run out quickly during a pandemic.  Stockpiling is one strategy to attempt to ensure that healthcare workers (HCWs) providing direct care to infectious patients can be provided with respiratory protection and other PPE.  This strategy will help prevent influenza transmission to HCWs and assist healthcare facilities to continue functioning and caring for ill patients during a pandemic. 
Each region must determine the amount of PPE they intend to stockpile and the process for distributing it.  You can learn about the PPE stockpiling in your region by contacting your HRSA Regional Hospital Resource Center Coordinator (RHRC). 

3M has created a web-based PPE planning calculator that can be helpful to persons doing such planning.  This calculator can help determine the amount of PPE that might be needed in various scenarios.  Respirators are the most critical item to stockpile, but other items may also be stockpiled, e.g., gloves, gowns, face shields or goggles. 

Is MDH planning to implement a fit testing respiratory protection program with clinics? The airborne transmission recommendation has implications for clinics that they are currently not able to accommodate due to lack of resources.  Most clinics do not (and will not) use a full respiratory protection program on a daily basis, therefore justification of the expense and time to implement pre-emergency is difficult.

The MDH website contains information about respiratory protection programs, including a model template that can be used by clinics and other healthcare settings.

  • Fit Testing
    Find out when to fit test, and how to conduct the tests.

MDH will also be working with RHRCs and District Office staff to determine gaps and needs for increasing the capacity of hospitals, clinics, and other agencies to fit test their staff and identifying ways that MDH can help assist with these needs. 

What are the guidelines for PPE use/refuse, time limit how frequently to change respirators, etc.?  This will impact the number we will try to order.

The issue of respirator reuse is critical in healthcare facilities since supplies of N95 respirators will likely be limited in a pandemic.

In early 2006, the Institute of Medicine (IOM) convened a group to explore options for reuse of N95 respirators during a pandemic. This group concluded that little is known at this time about the effectiveness of cleaning/disinfection methods or the performance of N95 respirators after cleaning/disinfecting. Additional research is needed and NIOSH is currently evaluating proposals for research in this area.

N95 respirators are fatiguing to wear and most persons cannot tolerate wearing one for more than 4 hours.  Respirators will continue to function effectively through many uses.  However, the issue of contamination is currently a limitation of reuse when respirators are used in the care of patients infected with pathogens that can be spread by contact, in addition to respiratory aerosols.

Will MDH provide guidance on PPE to non-health organizations, e.g. schools and businesses?  If not, who will?

Yes.  MDH is working with the Department of Education and the business community to provide infection control guidance as a part of pandemic planning. More information can be found at:

What is the lowest level of PPE to protect from airborne transmission for: 1) healthcare workers; and the 2) general population?

Appropriate PPE for healthcare workers for pandemic influenza includes respiratory protection (N95 or higher respirator or powered air-purifying respirator).  Also, because influenza may also be spread via respiratory aerosols and contact, gowns, gloves, and eye protection are also important.  Surgical masks do not provide protection to the wearer against inhalation of respiratory aerosols, but may offer some protection against large droplets that may be deposited in the nose or mouth.  The purpose of a surgical mask is to help contain respiratory aerosols expelled by the wearer.  The principles of respiratory protection are the same in the hospital and in the community, although healthcare workers caring for infectious patients are at much greater risk of exposure/infection and therefore have more need for respiratory protection.  

Is there any funding for PPE for non-healthcare responders?

Ask your Regional Hospital Resource Center Coordinator.  Regional planning varies, but some regions may be identifying PPE funding for non-healthcare responders.  However, PPE should be prioritized for persons at the greatest risk of exposure to infectious patients. 

Does the general public need to be fit tested if they wear N95 respirators for protection against airborne virus?

No.  Fit testing is an Occupational Health and Safety Administration (OSHA) requirement for employers.  There are no requirements for the general public to be fit tested prior to use of an N95 respirator.  Caregivers of persons with avian/pandemic influenza should be instructed in the proper placement and fit checking of an N95 respirator.  A non-fit tested N95 respirator will provide more protection to the wearer than a surgical mask or no respiratory protection at all. 

Cleaning and disinfecting surfaces and contaminated objects - what solution? Bleach? If so, what ratio?

Avian influenza virus is inactivated by a range of disinfectants, including: phenolic disinfectants, quaternary ammonia compounds, household bleach, alcohol, other germicides with a tuberculocidal claim on the label, and other registered/licensed disinfectants.  Use manufacturer’s recommendations for use/dilution, contact time, and handling.  If a bleach solution is used, the dilution should be ¼ cup household bleach to 1 gallon of water and this solution must be mixed fresh daily.
Patient rooms/areas should be cleaned at least daily and terminally cleaned at discharge.  Potentially contaminated objects and surfaces should be cleaned and disinfected after each patient use, or at least daily in the patient’s home. 

Have infection control precautions changed for seasonal to match the ones for pandemic?

No, not at this time.  Although all types of influenza are presumably spread in the same ways, a higher level of respiratory protection is recommended for avian and pandemic influenza because unlike seasonal influenza: 

  1. There is currently no preventive vaccine.
  2. Antivirals may not be efficacious or available.

In a pandemic younger, healthy persons (such as healthcare workers) may have the greatest risk of morbidity and mortality.

 

 

Updated Tuesday, 16-Nov-2010 12:21:48 CST