Preparedness and prevention are critical issues as we face the ongoing pandemic of novel H1N1 influenza and the arrival of seasonal influenza.
Keep politics out of H1N1 preparedness debate
The Society for Healthcare Epidemiology of America, or SHEA, has consistently emphasized the need for a comprehensive approach to controlling the transmission of H1N1 influenza, particularly in healthcare settings. We have advocated practical, evidence-based solutions that work in concert to produce an effective prevention net: vaccination; hand hygiene; respiratory etiquette; early identification and triage of infected persons; isolation of persons with an influenzalike illness; exclusion of ill visitors and healthcare workers; and lastly, use of personal protective equipment, such as gloves, gowns, masks or respirators.
We know that consistency is the most effective means to prevent transmission of respiratory viruses, such as H1N1 influenza.
Unfortunately, many of the basic messages about prevention and preparedness have been overshadowed by fear—and worse, politics. The results are finger-pointing, wasted time and resources, and a failure to make patients, healthcare workers and the public safer.
The SHEA approach to effective influenza prevention is supported by scientific research and clinical experience and is the foundation for guidance from the Centers for Disease Control and Prevention and the World Health Organization. That's why it is troubling that so much attention has been diverted to a debate over respiratory protection. We know the most important factors in prevention are to do what works, do it early and do it every time—universal influenza vaccination should be the obvious first-line strategy.
Early in the pandemic, the CDC had to try to stem the spread of a new and potentially deadly virus while trying to minimize the disruption to society caused by travel restrictions and school closures. In the absence of good data about the emerging virus, it made sense to recommend initially that healthcare workers use N95 fit-tested respirators to care for patients with H1N1 influenza.
As we have gained experience, we've come to appreciate that H1N1 influenza behaves very much like seasonal influenza and thus we can use the same precautions for both, such as the use of simple surgical masks for routine care. This is the viewpoint of SHEA and other professional societies such as the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America and the Association of State and Territorial Health Officials. Our recommendations were supported by the CDC's own external advisory committee and the President's Council of Advisors on Science and Technology.
As a practitioner who has great respect for the CDC, it has been frustrating to watch a misguided labor community thwart the CDC's mission and overshadow the expertise of the scientific community. Hype and labor politics have trumped science and common sense, and instead of an emphasis on proven prevention methods, labor leaders stress respiratory protection through use of cumbersome, uncomfortable, more expensive and clinically unproven N95 respirators.
This is a very significant issue that affects healthcare workers across the continuum of care. Fit-testing healthcare workers and requiring use of N95 respirators will likely cost billions of dollars and will not result in improved healthcare worker safety.
True preparedness and prevention demand that we focus on the following issues:
We must demand that all who can be vaccinated against the H1N1 virus have access to and receive the vaccine.
Infection control and prevention efforts must continue in healthcare institutions of all kinds and prevention measures should be applied to community settings where the risk of transmission is potentially higher than that seen in healthcare settings.
Prevention must emphasize all strategies known to work—disproportionate emphasis on one approach will waste resources and fail to achieve effective results.
Effective communication must occur between the CDC, local health departments and healthcare institutions about the emerging science and about practical implementation issues.
Vaccine and equipment manufacturers must collaborate with the healthcare community to anticipate and thus produce sufficient resources for prevention.
Rapid investment must be made in rigorous scientific investigation to answer remaining questions about virulence, transmissibility and the most cost-effective prevention methods.
The CDC and other agencies must continually re-examine the evidence from clinical practice to inform policies and guidance.
Ultimately, everyone has a responsibility to take action for preventing the further spread of novel H1N1 influenza. Infection-control guidance should be based on scientific knowledge and clinical evidence and should be practical and cost-effective. Knowing what works, but not implementing it as the science dictates, will surely make this situation much worse.
Mark Rupp is president of the Society for Healthcare Epidemiology of America and a professor of internal medicine at the University of Nebraska Medical Center, Omaha.
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