Consider requiring face protection for certain procedures

Given the risk of health care workers acquiring infections on the job, some hospitals may strengthen their infection control policies to require face protection for all cough-inducing procedures.

Although some may consider that unnecessary, others believe it’s simply being responsible given the possible return of the SARS virus this winter. In addition, the CDC plans to issue new guidelines for hospitals that may advise having patients and visitors wear surgical masks, something never before proposed by federal health officials, the Associated Press reports. At the time BOIC went to press, the Department of Health and Human Services had not approved the CDC’s guidelines.

Renee Patterson, CSP, infection control manager at Ingham Regional Medical Center in Lansing, MI, says the facility’s respiratory services department is confident its current policy is sufficient. “We are not doing anything different than before,” she says. “We train employees to do it right to begin with.”

This includes taking standard precautions and treating all patients as though they have an initial infection, but doesn’t necessarily require the health care worker treating the patient to wear a mask every time.

Certain procedures, such as bronchial ones, require a mask, but Patterson notes that masks are not required for patients with simple coughs.

Patterson isn’t aware of any incident reports of infections sustained by employees who deal with respiratory infections. These employees receive the proper training and personal protective equipment to shield them from exposure, she adds.

“These are the minimal precautions. We’re not going to stop” an employee who wants to wear a mask for every procedure, Patterson notes.

It might seem unnecessary, but requiring face protection for every cough-inducing procedure may someday be the norm, says Terri Rebmann, RN, MSN, CIC, infectious disease specialist at Saint Louis University School of Public Health.

“Right now, doing it for every procedure might be overreacting,” she says. “I lean toward conservative but rational. If you’ve got a patient who’s coughing, it’s safer to put on a mask and put a mask on the patient. You don’t know if the patient has the flu, SARS, or the pneumonic plague.”

A conservative approach makes sense, considering SARS symptoms closely resemble those of the flu, Rebmann notes. In recent months, there have been influenza outbreaks in other locations, such as Canada and Hong Kong, that local health officials treated as possible SARS outbreaks until they could be confirmed otherwise. “When it really hits the United States, hopefully the U.S. would respond the same way,” Rebmann says.

When determining how to proceed in these matters, hospitals should consider that most federal guidelines leave these decisions to the facility, says Robert J. Sharbaugh, PhD, CIC, a consultant with Risk Tech based in Charleston, SC.

“OSHA requirements say you need gloves under certain situations,” he says. “Beyond that, they’re not nearly as specific. If you think there’s the potential for exposure of nebulization, aerosol, etc., you should wear a mask, but it’s up to you.”

The CDC’s standard precautions address barrier protection, Sharbaugh adds.

“It doesn’t matter if you’re dealing with AIDS patients or whatever, you treat everyone as being potentially infectious and act accordingly,” he says. “It’s a fairly simple concept and left up to the provider.”

Most facilities have an exposure control plan, which OSHA mandates, says Sharbaugh. In addition, “your policy could simply be to follow the standard precautions as suggested by the CDC,” he advises.