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CDC updates H1N1 Infection Control Guidance, reaffirms N-95 use with options

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October 19, 2009

CDC updates H1N1 Infection Control Guidance, reaffirms N-95 use with options

The CDC has issued revised “Interim guidance on infection control measures for 2009 H1N1 influenza in healthcare settings, including protection of healthcare personnel” that affirms the need for N95 respirators for close contact and high-risk procedures and provides options when supplies are short.

The revised guidance stresses a comprehensive approach that reduces risk of exposure and that is flexible if changes in the plan become necessary.
The CDC recommendations include the following:
  • Vaccinate for H1N1 and seasonal flu.
  • Enforce policies to keep ill staff at home.
  • Screen visitors and staff.
  • Enforce respiratory hygiene and cough etiquette for all.
  • Manage suspect or confirmed cases of flu:
    • Single patient room.
    • Use standard precautions.
    • Use fit tested N95 respirators for patient contact within 6 feet.

Shortages of N95 respirators – prioritization of use

The revised CDC recommendations strike a balance between the conceptual basis of transmission of H1N1 by small and large droplets traveling a short distance (within 6 feet) and the critical supply issues.

  • Assess the supply of N95 respirators and take measures to ensure adequate supply to cover situations and procedures that have the greatest risk for transmission.
    • Ensure that N95 respirators are used during aerosol-generating procedures (e.g., bronchoscopy, CPR, open suctioning of airways) or when caring for patients with TB. If N95 respirators are not available, consider a higher level of protection, such as powered air-purifying respirators (PAPR).
  • Minimize the number of individuals requiring respiratory protection through use of other control measures.
  • Consider extending the use of disposable N95 respirators in special situations for multiple patient encounters (e.g., during triage).
  • In situations of respirator shortage, provide FDA-approved facemasks to healthcare workers who are not participating in aerosol-generating procedures but providing routine care using a prioritization plan.


  • Document your prioritization plan for respiratory protection as part of your overall H1N1 preparedness plan.
    Prioritization of respiratory protection includes consideration of:

    • Vaccination status of workers.
    • Type of procedure (routine care versus aerosol-generating procedure).
    • Frequency of close exposure (e.g., within 6 feet).
    • Risk factors for complications (e.g., pregnant workers).
  • Document the respirator shortage (e.g., copy of order placed or statement from supplier that product
    is unavailable).

View related documents on infection control in healthcare settings and respirator use.

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