The CDC, the states, and credibility....

Yes, I’m posting again about the CDC’s seeming inability to back down from an unreasonable and unsustainable infection control guideline for the novel H1N1. Why, you might wonder, should I care about this any longer? After all, the Iowa Department of Public Health has now joined Minnesota in adopting the WHO approach to preventing transmission of H1N1 in healthcare facilities (droplet + standard, with N95s for aerosol-generating procedures). So we’ve used that guidance to support a change in approach at our university hospital.

However, we have a university-affiliated VA as well. As our VA hospital epidemiologist, I’ve recommended we take a consistent approach to this at both hospitals (since many of our clinicians see patients in both facilities). Today I’ve been told we can’t do that—as a federal facility, we are bound to follow the CDC guidance. So now we have two very different approaches to prevention of H1N1 transmission in our two hospitals, a less-than-ideal situation.

I understand that CDC may be having a push-and-pull with OSHA on this, and feels obligated to fully investigate instances of healthcare worker infection with novel H1N1 before they change their guidance. But what will they possibly learn from healthcare worker H1N1 cases that will provide the evidence they seek, when we know that the use of N95 versus standard surgical masks to prevent pathogen transmission is not evidence-based to begin with? Sigh.

I believe that the CDC response to the novel H1N1 has been excellent overall—rapid, transparent, and calibrated over time to reflect new information as it is available. On this point, however, the CDC risks losing some credibility—once state departments of public health lose patience and begin to change to the WHO guidance, as is currently happening, the CDC looks increasingly out of touch with what is happening on the ground


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