MOSH Issues Guidance on Protecting Healthcare Workers from Swine Flu


BALTIMORE (11/03/09) - In response to many questions surrounding the HIN1 (swine flu) pandemic and its impact on workers at healthcare and emergency medical facilities, Maryland Occupational Safety and Health (MOSH), which is part of the Department of Labor, Licensing and Regulation's Division of Labor and Industry, announced it is taking its enforcement lead from the Centers for Disease Control's (CDC) Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel, to ensure that these employers take adequate steps to protect workers against the H1N1 virus. MOSH will also take guidance from the federal Occupational Safety and Health Administration's (OSHA) soon-to-be-released compliance directive for H1N1.

The CDC's interim guidelines recommend a hierarchy of controls approach to prevent exposure of healthcare personnel to flu transmission within healthcare facilities. These controls, in order of preference, include:

  1. elimination of potential exposures (e.g., minimizing outpatient visits for patients with mild flu-like illnesses who do not have other risk factors, postponing elective visits by patients with suspected or confirmed flu, discouraging entry to visitors who are sick, etc.)
  2. engineering controls (e.g., installing partitions in triage areas, shielding personnel and patients, use of closed suctioning systems for airways suction in intubated patients, etc.)
  3. administrative controls (e.g., promoting and providing vaccinations, enforcing exclusion of ill healthcare personnel, implementing respiratory hygiene/cough etiquette, managing patient flow, etc.)
  4. personal protective equipment (e.g., required use of NIOSH-certified respirators, N95 or better).
    Additional, specific examples of recommended controls are discussed in the CDC guidance document.

One major concern for healthcare facilities is respiratory protection for workers exposed to individuals with a suspected or confirmed case of H1N1. The CDC continues to recommend devices that are at least as protective as a fit-tested, disposable N95 respirator. When the employer requires that respirators be worn it must implement a respiratory protection program that meets the OSHA/MOSH Respiratory Protection Standard. The employer must also appoint a Respirator Administrator.

Due to a shortage of N95 disposable respirators, MOSH expects healthcare employers to follow CDC interim guidance by monitoring respirator supplies and prioritizing their use of N95 respirators, and to consider using more protective disposable respirators (N, R, or P types with 95, 99 or 100 per cent efficiencies) or elastomeric respirators - face pieces with disposable cartridges or filters that are made for longer-term use - if shortages continue. This is because the H1N1 virus can pass through less rigorous filtering means. Healthcare workers performing high hazard aerosol-generating procedures (e.g., bronchoscopy, open suctioning of airways, etc.) on a suspected or confirmed H1N1 patient must always use respirators at least as protective as a fit-tested N95, even where shortages exists. If respiratory protection is not commercially available, an employer will be considered in compliance if it can show it made a good faith effort to acquire respirators and that it has implemented an acceptable hierarchy of controls to prevent employee exposure to influenza within the healthcare facility.