CDC questions mask use in pandemic plan

Form flu patient cohorts if necessary

A draft influenza plan obtained from the National Vaccine Program Office (NVPO) of the Centers for Disease Control and Prevention includes infection control recommendations for health care facilities during an influenza pandemic, which are summarized below:

Staff education: Educate staff about the epidemiology and prevention of influenza. This should be an annual event and should be repeated and geared toward a wider audience when a pandemic is expected. Extra effort should be made to ensure that all staff participate in this program, including nurses who work on a part-time basis, other staff who may not routinely care for patients but might be required to do so in the event of a pandemic, and non-patient-care staff (e.g., administrative, medical records, and food service personnel). Use of dedicated staff who have been immunized should be considered for care of those with suspected or confirmed influenza infection.

Hand washing and gloving: Decreasing the risk of transmission of microorganisms in health care settings, accomplished primarily by hand washing, is a major component of infection control. Hands should be washed after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Hand washing with plain soap or detergent for at least 10 to 15 seconds under running water is an effective method of removing soil and transient microorganisms. If sinks for hand washing are not readily available, alcohol-based agents can be used. However, hand washing with soap and water should be done after every 10 to 15 uses. Clean, non-sterile, disposable gloves should be worn when touching blood, body fluids, secretions, excretions, and contaminated items. Gloves should be removed after use and before touching any noncontaminated items or touching another patient, and hands should be washed immediately with soap and water or an antiseptic handrub.

Masks: Ideally, to be consistent with droplet precautions, health care workers and visitors should wear masks when they are within three feet of the patient, and the patient should wear a mask when being transported. However, this may not be practical during a pandemic, and health care institutions may want to consider limiting the use of masks for containment of other pathogens. Use of masks to prevent transmission of influenza in the community is also not likely to be effective.

Bed management: Isolation plans for use during a pandemic should be developed in advance. Under ideal circumstances, patients with suspected or diagnosed influenza should be in a private room. Special ventilation is not necessary. During a pandemic, private rooms are unlikely to be available, and containment of infection is likely to be difficult. Consideration should be given to cohorting patients with active influenza infection (during a pandemic, all influenza infection is likely to be with the same influenza strain).

Isolation procedures for other pathogens, including use of a private room, should continue to be used. The period of greatest communicability of inter-pandemic influenza is the first three days of illness, but the virus can be shed before onset of symptoms and up to seven or more days after illness. It is possible that more prolonged shedding could occur with pandemic influenza because the immune system would not have prior experience with related strains. Therefore, all influenza-specific bed management measures should be maintained for at least seven days after onset of illness, or longer if symptoms persist.

Movement and transport of infected patients should be limited as much as possible. If a patient must be transported, he or she should wear a surgical mask to decrease the risk of virus transmission to other patients and health care workers. Patients also should be educated about personal hygiene measures that decrease virus transmission, such as covering their mouth and nose when coughing or sneezing. Congregation of patients not infected with influenza should be minimized to prevent spreading of illness by nonsymptomatic or undiagnosed persons.