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IOM Recommendations. N95 Respirators Best Defense Against Flu for Health Care Workers
American Family Physician, 09/14/09

The Institute of Medicine has endorsed the CDC's recommendation that health care workers who interact with patients with novel influenza A (H1N1) infection or influenza–like illnesses should use fit–tested N95 respirators. Although some N95 respirators allow a little more than 5 percent particle penetration, they still have protection factors that are eight to 12 times greater than those of traditional medical masks, which do not seal to the face. Also health care organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, hand–washing, disinfection, gloves, vaccination and antiviral drug use.
Human transmission of influenza virus is thought to occur primarily in three ways:

• contact exposure, in which the virus is transferred by direct physical contact between an infected person and an uninfected person or indirectly through exposure to contaminated objects or surfaces;
• droplet spray exposure from coughing or sneezing;
• and airborne inhalation exposure.

The relative contribution of each of these possible routes of transmission is unknown and urges that more research be pursued in this area.
Some health care workers may not come to work during a pandemic if they do not feel safe, the report says. Therefore, health care facilities and physician offices should create a culture of worker safety that mirrors their commitment to patient safety. Doing so will require planning; education; personal protective equipment, or PPE; materials; organization; and patient isolation.

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