On behalf of our 37,000 members, we call on you to ensure that registered nurses and other healthcare providers are adequately protected against the H1N1 influenza virus, which is expected to affect large numbers of the population this fall.

A report released on Sept. 3 by the Institute of Medicine (IOM) states that the minimum protection for workers (including those in non-hospital settings) who are in close contact with patients with suspected or confirmed H1N1 influenza is a fit-tested N-95 respirator. The recommendation conforms to guidelines issued by the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health.

DOH guidelines must be updated

Influenza is transmitted three ways: droplet (between 5 and 10 microns), airborne aerosol (less than 5 microns), and contact. With H1N1, which primarily attacks the lungs, airborne infection has an important role to play. Because it allows viruses to enter the deep lung tissue more easily and can cause illness at lower doses than the other two modes, airborne transmission is a clear hazard for workers.

The New York State Department of Health has issued guidelines stating that a surgical mask is appropriate protection for routine care of patients with respiratory illness. Surgical masks, however, do not provide adequate protection against airborne aerosols. The DOH guidelines must be updated to require fit-tested N-95 respirators (or better) for all workers who will be caring for flu patients.

Facilities must invest in infection control

Healthcare facilities are trying to increase their surge capacities in the event of an epidemic. But they must also invest in protecting the nurses who will care for these patients. As we have already communicated to DOH, even when they are vaccinated, employees can still get the flu and spread it to others if they are exposed to the virus without proper protection.

When novel H1N1 influenza appeared last spring, nurses were concerned about the appropriate infection control measures when caring for suspected H1N1 cases. When the Nurses Association evaluated the readiness of hospitals to deal with a possible public health emergency, we were shocked to discover that many facilities were unprepared.

Some hospitals did not have enough N-95 respirators available and had not performed the necessary fit testing. Some had not completed the OSHA-required risk assessment process. Respiratory isolation rooms were either not available or were poorly maintained, work practices were not adequate, and pertinent policies were either outdated or nonexistent.

Mandatory immunizations are not an “easy fix” that will prevent workers from contracting seasonal flu or H1N1. To effectively prevent the spread of infection, healthcare facilities must establish and implement effective infection control policies and procedures and DOH must ensure that federally mandated infection control procedures are being followed.