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6 Moving Forward with Urgency If an influenza pandemic were to occur within the next 6 months or in the near future, it is likely that many of the healthcare challenges faced in addressing severe acute respiratory syndrome would be repeatedâ healthcare institutions and healthcare workers would face decisions about what types of personal protective equipment (PPE) would offer effective prevention; many healthcare workers would not have received recent training on the appropriate use of PPE; and questions about the effec- tiveness of PPE in preventing influenza transmission would raise con- cerns. As a result, the surge capacity to treat ill patients could be severely impaired. This report emphasizes the current lack of preparedness for effective use of personal protective equipment and acknowledges that PPE is one component of a set of strategies that offer protection to healthcare workers such as vaccines, antiviral medications, and infection control practices including hand hygiene and environmental and adminis- trative controls. The committee believes that improvements should be made so that healthcare workers have PPE that provides protection against influenza transmission based on a rigorous risk assessment with solid scientific evidence. However, this level of protection will require increased re- sources dedicated to answering the critical questions that remain regard- ing the transmission, prevention, and mitigation of influenza. Consideration should be given to the range of healthcare workplaces (in- cluding home care, nursing homes, private practices, and hospitals), the multiple types of healthcare workers who come in contact with patients or face exposure to influenza (e.g., administrative and housekeeping staff, physicians, nurses), the diverse tasks they perform with varying degrees of exposure risk, their diverse educational and cultural backgrounds, and 169
170 PREPARING FOR AN INFLUENZA PANDEMIC their diverse work environments (some of which have engineering or other controls, such as ventilation, in place). The current paucity of data on influenza transmission is hindering research and development efforts for PPE and for other influenza preven- tion and control measures. Until more is known about influenza trans- mission, it will be critical to follow current infection control practices, to ensure that all forms of protection are available to healthcare workers, and to heighten their knowledge of PPE and its use, while also obtaining the input of healthcare workers in designing, testing, and developing the next generation of PPE. It is hoped that this report will catalyze initia- tives to promote a strong emphasis on the safety of healthcare workers. Respiratory protection and some other forms of PPE have been de- signed primarily for industrial exposures. Increased focus should be placed on the unique needs of healthcare workers who are a substantial percentage of the U.S. workforce (approximately 10 percent) and who require PPE that allows for interaction with and care of patients and pro- vides protection to both the wearer and the patient. The set of recommendations emerging from this report can be grouped into three broad categories with the overarching theme of rigor- ously ensuring the safety of healthcare workers so that they can continue to care for and protect their patients as shown in Figure 6-1. The task of the committee focused on protecting workers in the emergency situation of an influenza pandemic; however, the improvements resulting from implementation of the recommendations in this report have the potential to further enhance worker safety in other healthcare situations as well as in other industries and workplaces. Ensuring Healthcare Worker Safety during an Influenza Pandemic Understand Influenza Innovate and Commit to Worker Safety Transmission Strengthen PPE and Appropriate (Recommendation 1) Design, Testing, and Use of PPE Certification (Recommendations 6-8) (Recommendations 2-5 and 9-12) FIGURE 6-1 Opportunities for action.
MOVING FORWARD WITH URGENCY 171 â¢ Understanding influenza transmissionâInfluenza transmission research should become an immediate and short-term research priority so that effective prevention and control strategies can be developed and re- fined. This research has the potential for significant gains in knowledge within 1 to 3 years if the concerted efforts and increased resources of a multicenter research network are brought to bear on the critical questions. â¢ Commit to worker safety and appropriate use of PPEâDue to a number of challenges including the wearability of available equipment and the lack of organizational and individual commitment to appropriate use of PPE, many healthcare workers do not currently use PPE in situa- tions in which they face the prospect of hazardous exposures. Efforts are needed to strengthen the culture of safety in healthcare facilities and to support institutional commitments to worker safety, including use of PPE, by healthcare organizations, healthcare workers, and training and accred- iting organizations. â¢ Innovate and strengthen PPE design, testing, and certificationâ Using PPE to deliver health care places demands on the design and engi- neering of these products that are particularly focused on interactions with patients and ensuring that healthcare workers do not become in- fected and do not transmit infection. An integrated effort is needed to further understand the requirements of the worker and to develop innova- tive materials and technologies that can meet these needs. Increasing the use of field testing in the pre-market phase and conducting thorough post-marketing evaluations are vital to producing effective equipment. Further, federal agencies and other organizations with oversight should ensure that rigorous testing has been conducted and that effective equip- ment is approved and used appropriately in the workplace. Being ready for an influenza pandemicâhaving the necessary re- sources to minimize morbidity and mortalityâis the goal of ongoing global efforts in many areas of endeavor. Because healthcare workers are essential for providing patient care during a pandemic, the PPE that can protect these workers from becoming infected or from transmitting infec- tion is a vital part of these efforts. Healthcare worker safety is essential for patient safety and patient care. Being prepared for an influenza pan- demic places a priority on protecting the healthcare workforce.