Monday, April 27, 2009

All Swine Flu, All the Time

It looks like a busy week ahead for infection preventionists, filled with meetings about pandemic preparedness--assessing antiviral stocks and isolation/mask supplies, discussing bed management and negative pressure room availability, and determining how best to improve surveillance and disseminate information about diagnostic testing, antiviral use, and infection control guidance. My schedule is already near full for tomorrow with meetings about these issues at our VA and University hospitals.

I won’t be blogging all the developments as they occur, since you can find the latest updates at the CDC and WHO swine flu websites. I will only comment when I have time or to address specific controversial issues.

One interesting issue comes out of the CDC guidance for infection control in healthcare facilities. While this guidance calls for standard + droplet + contact precautions for suspected/confirmed cases, it also expresses a preference for N95 masks during direct patient care and negative pressure rooms, which sure sounds a lot like airborne isolation to me! I’m recommending the same type of isolation we’ve recommended for avian flu or SARS, which we call combination precautions (essentially a combination of standard, airborne, and contact precautions).

The CDC infection control guidance for swine flu is a bit maddening, since it uses different distance parameters than traditional droplet precautions (6 feet rather than 3), and in other respects doesn’t fall neatly within either airborne or droplet categories. The reasons for this are twofold: (1) we don’t yet know enough about the transmissibility of the new swine flu virus, and (2) we know that not all respiratory pathogens fall neatly within droplet or airborne transmission categories. It would nice if pathogens either traveled for long distances on air currents or fell to the earth in large droplets within 3 feet of expectoration. Unfortunately, as we learned with SARS, the situation is far more complicated.

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