Objective

This document provides guidance to Davidson College employees and students for the use of personal protection equipment (PPE) in areas and situations which involve persons with novel influenza A (H1N1) virus infection or influenza-like illness (ILI).

If used correctly, PPE can help prevent some exposures; however, they should not take the place of other prevention interventions, such as engineering controls, cough etiquette and hand hygiene (see www.cdc.gov/flu/protect/stopgerms.htm ).

Background

Novel influenza A (H1N1) is a new flu virus of swine origin that first caused illness in Mexico and the United States in March and April, 2009. It's thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread, mainly through the coughs and sneezes of people who are sick with the virus, but it may also be spread by touching infected objects and then touching your nose or mouth. Novel H1N1 infection has been reported to cause a wide range of flu-like symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, many people also have reported nausea, vomiting and/or diarrhea.

On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6 , pandemic wide spread human infection. This action was a reflection of the spread of the new H1N1 virus, not the severity of illness caused by the virus. Although most flu symptoms are mild and last only a few days without treatment, health officials worldwide are concerned because the virus is new and could easily mutate and become more virulent.

Definitions:

o Facemasks:Unless otherwise specified, the term "facemasks" refers to disposable facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs.
The type of facemask used at Davidson College is flat/pleated and affixes to the head with ear loops.
Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids. Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not designed to protect against breathing in very small particle aerosols that may contain viruses. Facemasks should be used only once and then thrown away in the trash.

These facemasks are available through the Physical Plant stores via a work order, ext.2595

o Respirators:Unless otherwise specified, "respirator" refers to an N95 or higher filtering face piece respirator certified by the CDC/National Institute for Occupational Safety and Health (NIOSH). A respirator is designed to protect the person wearing the respirator against breathing in very small particle aerosols that may contain viruses. A respirator that fits snugly on the face can filter out virus-containing small particle aerosols that can be generated by an infected person, but compared with a facemask it is harder to breathe through a respirator for long periods of time. Respirators are not recommended for children or people who have facial hair. Anyone wearing this type of respirator must be fit tested according to OSHA standard 29 CFR 1910.134.  Contact Environmental, Health & Safety (ext.2929) to schedule fit testing.

Personal Protection Equipment Recommendations

While administrative and engineering controls and proper work practices are considered to be more effective in minimizing exposure to the influenza virus, the use of PPE may also be indicated during certain exposures. If used correctly, PPE can help prevent some exposures; however, they should not take the place of other prevention interventions, such as engineering controls, cough etiquette, and hand hygiene. Examples of personal protective equipment are gloves, goggles, face shields, surgical masks, and respirators (for example, N95).

The types of PPE recommended for pandemic influenza will be based on the risk of contracting influenza while working. The ill person should be asked to follow good cough etiquette and hand hygiene and to wear a face mask at all times when other people are in the area.

• Eye protection generally is not recommended to prevent influenza infection although there are limited examples where strains of influenza have caused eye infection (conjunctivitis).
• Gloves Everyone should wash hands frequently with soap or sanitizing solutions to prevent hands from transferring potentially infectious material from surfaces to their mouths or noses. While people may choose to wear gloves, the exposure of concern is touching the mouth and nose with a contaminated hand and not exposure to the virus through non-intact skin (for example, cuts or scrapes). While the use of gloves may make persons more aware of potential hand contamination, there is no difference between intentional or unintentional touching of the mouth, nose or eyes with either a contaminated glove or a contaminated hand. Anyone wearing gloves should always wash their hands with soap or sanitizing solution immediately after removal to ensure that they did not contaminate their hand(s) while removing them.
• Respirators/FacemasksIn the absence of clear scientific data, the Centers for Disease Control (CDC) have given the following interim recommendations. These have been developed on the basis of public health judgment, the historical use of facemasks and respirators in other settings for preventing transmission of influenza and other respiratory viruses, and on current information on the spread and severity of the novel influenza A (H1N1) virus. (1)

o The ill person should be asked to follow good cough etiquette and hand hygiene and to wear a face mask at all times when others are in the area.

o General work activities: Building Service workers, PP Maintenance, Public Safety

 workers should try to maintain a distance of 6 feet or more from the person with ILI;
 workers should keep their interactions with ill persons as brief as possible (<30 minutes);
 if workers cannot avoid close contact with persons with ILI, some workers may choose to wear a face mask or N95 respirator on a voluntary basis.

o Health Care setting: Student Health Center workers, ill students

 respiratory protection (N-95), for workers in the area for >30 minutes, and are in close contact (<6 ft.) with the ill person. An N-95 is to be worn while performing nebulizer treatments.
 facemasks for transitory contact
 ill persons should wear a facemask when others are in the room.
 ill persons should be placed in well ventilated areas when possible and placed in areas where at least 6 feet distance can be maintained between the ill person and other well and ill persons.

o Students:

 wear facemasks for transitory contact with ill person
 students who exhibit flu-like symptoms should wear a facemask when others are in the room
 facemasks for transitory contact with ill person
 students should keep their interactions with ill persons as brief as possible (<30 minutes)

In areas with confirmed human cases of novel influenza A (H1N1) virus infection, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These recommended actions are:

• Wash hands frequently with soap and water or use alcohol-based hand cleaner when soap and water are not available.
• Cover your mouth and nose with a tissue when coughing or sneezing.
• Avoid touching your eyes, nose and mouth
• People who are sick with an influenza-like illness (ILI) (fever plus at least cough or sore throat and possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhea) should stay home and minimize contact with others, including avoiding travel, for 7 days after their symptoms begin or until they have been symptom-free for 24 hours, whichever is longer.
• Avoid close contact (i.e. being within about 6 feet) with persons with ILI.

Reference:
(1) Centers for Disease Control and Prevention, May 27, 2009 Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission