KFF Health News: Healthcare workers warn relaxing mask advice in hospitals could harm patients and providers | News

Nurses, researchers and workplace safety officials are concerned that new guidelines from the Centers for Disease Control and Prevention could reduce protection against the coronavirus and other airborne pathogens in hospitals. .

This year, a CDC advisory committee is updating the 2007 standards for infection control in hospitals. After the group published its draft proposal in June, many medical experts and scientists expressed outrage.

The draft law is controversial, but it states that N95 face masks are equivalent to loose surgical face masks in certain situations, and could protect patients infected with “common endemic” viruses, such as those that cause seasonal influenza. It concludes that doctors and nurses should only wear surgical masks when treating patients. .

The committee was scheduled to vote on the changes on Aug. 22, but action was postponed until November. Once the advice is finalized, the CDC will begin the process of turning the committee’s evaluation into a guideline typically followed by hospitals across the country. After the meeting, members of the public expressed concerns about where the CDC is heading, especially as COVID-19 cases continue to rise. Nationally, the number of hospitalizations and deaths due to the new coronavirus have been increasing for several weeks in a row.

Gwendolyn Hill, a research intern at Cedars-Sinai Medical Center in Los Angeles, said after the committee’s announcement that “health care facilities are the places where the most vulnerable members of our population frequently enter and stay.” It’s the location,” he said. He said N95 masks, ventilation and air purification techniques can reduce the rate of transmission of the coronavirus within hospital walls and “ensure that people leave the hospital sicker than they were when they arrived.” It can be prevented.”

“We’re very happy to receive the feedback,” Alexander Cullen, director of CDC’s Division of Prevention and Response in the Division of Healthcare Quality Advancement, told KFF Health News. “Our goal is to develop guidelines that protect patients, visitors, and healthcare workers,” he said, adding that the draft guidelines are far from final.

In June, members of the Healthcare Infection Control Practices Advisory Committee, a group at the CDC, found no difference in infection rates between health care providers who wore N95 masks and surgical masks in clinics. It cited research and presented a draft report. They noticed flaws in the data. For example, many healthcare workers who contracted the coronavirus during testing did not become infected while wearing masks at work. But still, they concluded that the masks were equivalent.

Their conclusion contradicts a 2022 CDC report that found N95 masks reduce the chance of a positive coronavirus test by 83%, compared with 66% for surgical masks and 56% for cloth masks. It is. It also excludes a large clinical trial published in 2017 that found N95 masks were significantly better than surgical masks at protecting health care workers from influenza infection. And this follows an extensive assessment by Britain’s National Academy of Sciences, the Royal Society, that N95 masks (also known as N95 masks) are more effective against the coronavirus than surgical masks in medical settings around the world. It is contradictory.

“It’s shocking to suggest that more research is needed to know whether N95 masks are effective against airborne pathogens,” said Caitlin Sandling, an internist and pathologist at the University of Wisconsin-Madison. ” he said in comments after the June meeting. “The science behind N95 masks is well-established and is based on physical properties, man-made filter materials, and a scientific understanding of how airborne transmission works.”

Her argument is supported by the California Department of Occupational Safety, Cal/OSHA, which, if adopted, could conflict with the CDC’s rules for protecting at-risk workers from infection. There is sex. “The CDC should not undermine respiratory protection regulations by making false and misleading claims that there is no difference in protection between N95 masks and surgical masks,” said California/OSHA Industrial Hygienist. Deborah Gold made the comments at the August meeting.

Researchers and occupational safety experts were also perplexed by how the committee classified airborne pathogens. Surgical masks, rather than N95s, are a category of protection they created for “common, endemic” viruses that are transmitted over short distances and “for which individuals or communities are expected to have some degree of immunity.” proposed as. The committee’s representatives, researchers Hilary Babcock, Erica Shenoy and Sharon Wright, said hospitals should require all health care workers, patients and visitors to wear masks in hospitals. He was one of the authors of an editorial in June arguing that wearing them should no longer be mandatory. “The time has come to end policies that are inappropriate for endemic pathogens,” they wrote.

However, in a phone call with KFF Health News, Cullen said the committee has put coronaviruses that cause the common cold into that category, but not yet the coronavirus that causes COVID-19.

The committee’s next stage consisted of viruses in the “pandemic phase,” when the pathogen is new and there is little immunity from infection or vaccination. It recommended that healthcare workers wear N95 masks when treating patients infected with this category of insects. The third and highest layer of protection is reserved for pathogens such as those that cause measles and tuberculosis, which can spread further than the lower-tier threats and require N95s, they argued. .

Virologists said that biologically speaking, the committee’s categories have little basis. The way a pathogen spreads is not affected by the extent of its spread. Common viruses can still harm vulnerable populations. And many viruses, including SARS-CoV-2, can travel long distances in tiny airborne droplets.

“Massive coronavirus outbreaks in prisons and long-term care facilities demonstrate that the behavior of infectious aerosols cannot be easily classified, and these aerosols cannot be easily contained.” Eric Berg, deputy health chief for California’s Occupational Safety and Health Administration (OSHA), wrote: Letter of concern to CDC committee obtained by KFF Health News.

The committee gave conflicting reviews of N95 masks and their shortcomings. The draft cites a study from Singapore that found that nearly a third of healthcare workers (mainly nurses) said wearing such masks negatively affected their work, caused acne and other problems, and caused high temperatures and high temperatures. It is said that this condition is exacerbated by the harsh environment and long working hours. The study’s authors recommend a better-fitting mask and breaks instead of throwing away your mask.

Noha Aboelata, physician and CEO of Roots Community Health Center in Oakland, California, agrees. “If we decide it is unacceptable to administer COVID-19 to patients going to the hospital, there are other strategies that should be implemented, such as improved mask design and improved testing,” she said.

Aboelata was one of hundreds of doctors and researchers who signed a letter to CDC Director Mandy Cohen in July expressing concern that the CDC committee would weaken protections in hospitals. be. She also warned that cuts to N95 masks could impact emergency stockpiles and leave doctors and nurses vulnerable, as they were in 2020, when a shortage of masks caused an outbreak. More than 3,600 health care workers died in the first year of the pandemic in the United States, according to a joint investigation by KFF Health News and The Guardian.

The clinicians involved hope the committee will revisit the report in the light of additional research and perspectives by November. Roselyn de Leon Minch, an industrial hygienist with National Nurses United, said of the draft: “Codifying these standards of care would have a disastrous impact on patient safety and jeopardize the future. “It will also impact our ability to respond to health issues.” crisis. ”

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