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IOM affirms CDC guidance on N95 use in H1N1 setting

first_imgSep 3, 2009 (CIDRAP News) – The Institute of Medicine (IOM) today affirmed existing federal guidance that healthcare workers caring for H1N1 influenza patients should wear fit-tested N95 respirators, not just surgical masks, to protect them from the virus.At the same time, the IOM called for additional research on flu transmission and the effectiveness of various respiratory protection tools in clinical settings, along with efforts to develop new respiratory protection technologies to enhance safety and comfort.”Based on what we currently know about influenza, well-fitted N95 respirators offer health care workers the best protection against inhalation of viral particles,” said Kenneth Shine, chair of the committee that wrote the report, in an IOM news release.”But there is a lot we still don’t know about these viruses, and it would be a mistake for anyone to rely on respirators alone as some sort of magic shield,” added Shine, who is executive vice chancellor for health affairs in the University of Texas System, Austin, and former president of the IOM.. “Health care organizations and their employees should establish and practice a number of strategies to guard against infection, such as innovative triage processes, hand washing, disinfection, gloves, vaccination, and antiviral drug use.”But the IOM report drew criticism today from a representative of the Association of Professionals in Infection Control and Hospital Epidemiology (APIC), who said the recommendation to wear N95s fails to recognize the many practical and logistical problems related to N95 use, including discomfort, costs, shortages, and the difficulty of fit testing.In the face of unclear science concerning flu virus transmission, the IOM prepared the report at the request of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA).The panel, which was given just 8 weeks to write the report, held a 4-day meeting, including a 1 1/2-day public workshop, in August. The panel’s assignment specifically excluded the economical and logistical considerations related to personal protective equipment (PPE).The report notes that the current CDC guidance on protection for health workers caring for H1N1 patients differs from guidance from the World Health Organization (WHO) and Canadian guidance. The CDC recommends use of N95s for all healthcare workers who enter the rooms of patients in isolation with confirmed or suspected H1N1 infection. The same advice goes for emergency medical personnel who come in close contact with such patients.In contrast, the WHO recommends “standard and droplet precautions (including a medical mask, gown, gloves, eye protection, hand hygiene) for those working in direct contact with patients and additional precautions for aerosol-generating procedures including wearing a facial particulate respirator,” the report says. The recommendation allows for “the need for sustainability” in different countries.Similarly, recently released Canadian guidelines call for using N95s only during aerosol-generating procedures and recommend using medical (surgical) masks in other situations, according to the report.On the murky question of the extent to which flu viruses spread through the air, the IOM committee concluded that studies show that “airborne (inhalation) transmission is one of the potential routes of transmission.”The panel said it found few studies comparing the effectiveness of N95 respirators and medical masks in clinical settings, although several studies are under way. Hence the group based its decisions on comparisons of the two kinds of protection in controlled experiments. Those studies show that medical masks are unlikely to be effective in preventing aerosol transmission, the report says.In view of that evidence, the panel recommends that health workers in close contact with patients who have novel H1N1 flu or flu-like illness should wear fit-tested N95 respirators or respirators that are “demonstrably more effective.” The report specifically endorses the current CDC guidance and says it should be followed until there is evidence that other forms of protection work as well or better.In addition, the report advises that employers should make sure that N95 respirators are used and fit-tested in accordance with OSHA regulations.The panel further found that the need for more research on flu transmission and PPE is “striking.” It urges federal agencies and private organizations to support and undertake research to:Answer questions about the relative contribution of different routes of flu transmissionExplore the effectiveness of different respiratory protection tools in clinical settings through randomized trialsDesign and develop new respiratory protection technologies “to enhance safety, comfort, and ability to perform work-related tasks”The IOM’s recommendation to use fit-tested N95s drew criticism on practicality grounds today from Ruth Carrico, an infection control expert at the University of Louisville School of Public Health and Information Sciences and a former APIC board member. Carrico was on a panel of experts who reviewed the IOM report in draft form.”I think the IOM has missed the mark,” Carrico told CIDRAP News.She acknowledged that the panel of authors was specifically charged with looking only at the science and not the logistical and economic issues. But she said it’s difficult to separate the scientific issues from the logistical matters, such as the ability of health workers to follow the guidance and its applicability in clinical settings.”As a human being, if you’re being told this is the best protection for your and you go to work and that protection is not available, how likely are you to go to work the next day?” she asked.Noting that the recommendation specifically calls for the use of fit-tested respirators, Carrico said there are “lots of gaps” in the information about fit testing. Given the cost and time requirements of fit testing, she said, “Does it really make sense and is it a valid point? We have to be concerned about that in our economic times.”More generally, she said, “Divorcing the recommendations from the practicality of implementation represents a serious problem for healthcare workers who are trying to figure out, ‘What do I do to provide care for my patients in a safe manner?'”Hospitals say they do fit testing as best they can, but “there’s no way to be fit tested for all the kinds of respirators used,” Carrico continued. For example, this past spring, some hospitals ran out of respirators and hence used respirators from the government’s Strategic National Stockpile. Those were a different type from what hospitals normally use, which created a need for additional fit testing, she said.Keeping respirators on hand is a continuing problem, she added. “There are back orders; there are constant calls about interruptions in supply. We simply do not have the supply line of these types of materials in order to apply these recommendations.” As a result, hospitals try to save their respirators for us in the highest-risk settings.The shortages and other problems lead to inconsistent and changing hospital policies, which confuse workers, she added. “We’re hearing about workers who will say ‘I refuse to care for this patient because I don’t feel safe,'” she said.Carrico also commented that most workers can wear N95s only a short time before they become hot and uncomfortable.”At some point you’ve got to peel the onion and say what’s really necessary, what’s really practical, and how are we going to enable our healthcare workers to do what needs to be done?” she said.She also expressed hope that the IOM’s appeal for new research will lead to some well-designed studies in clinical settings.At a press briefing today, CDC Director Dr. Thomas Frieden said the CDC has just received the IOM report and is looking at it.CDC spokesman Tom Skinner said the agency is considering the recommendations from the IOM and other expert groups on the issue of respiratory protection for health workers. “We hope to have a plan that further addresses this issue very soon,” he told CIDRAP News.See also:Sep 3 National Academy of Sciences news release about the reporthttp://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12748Table of contents page for full IOM report “Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A”http://www.nap.edu/catalog.php?record_id=12748Aug 13 CIDRAP News story “Experts air practical PPE considerations to IOM”Aug 12 CIDRAP News story “IOM hears diverse findings on PPE for flu”last_img read more

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Daehli snatches late Cardiff point

first_img Solskjaer’s men had to wait until the 15th minute for their first chance, when Andrew Taylor’s low cross from the left evaded Gareth McAuley and almost fell at the feet of Fraizer Campbell. But having looked completely shell-shocked for much of the first period, Cardiff gave themselves hope on the half-hour when Aron Gunnarsson found Mutch on the right and the midfielder matched Amalfitano’s effort by curling the ball over Foster from 35 yards. For the first time, the home side’s nerves were evident although the excellent Amalfitano continued to dictate matters from the right flank, his good work setting up a chance for 1 Youssouf Mulumbu whose low shot was gathered well by Marshall. Solskjaer introduced another striker in Daehli at the break but it was West Brom who once again made the best start to the second period, Dawson twisting a shot over the bar then getting in the way of an apparently goal-bound effort from Mulumbu. And Marshall had to get down bravely to deny Vydra at close-range in the 52nd minute before James Morrison blazed the rebound high. The tiring Amalfitano was replaced by Saido Berahino in the 72nd minute as Mel made plain his intention to try to make the game safe – but moments later a Medel free-kick spelled disaster for the Baggies. Caulker rose highest to reach the set-piece in a crowded box and while he may not have known too much about it, his back-header looped over the helpless Foster and into the corner of the net. It marked an astonishing change in fortunes for Solskjaer’s men after their nine-minute nightmare, and it was clear their massed ranks of fans behind Foster’s goal believed they could go on and claim all three points. Substitute Daehli wriggled in the left side of the Baggies box and hit a shot straight at Foster, before the late, late drama – celebrations for Thievy’s winner were stunningly cut short by Daehli at the other end. Daehli turned and fired an injury-time equaliser past Baggies keeper Ben Foster just moments after Thievy Bifouma looked certain to have grabbed a first home win for boss Pepe Mel at the other end. The late drama summed up a wildly open game in which the visitors were lucky to still be in with a shout after a torrid first 10 minutes. An outrageous second-minute opener from Morgan Amalfitano and a second from Graham Dorrans had threatened to put the home side out of sight as the day looked like it was turning into a nightmare for Cardiff manager Ole Gunnar Solskjaer. But a long-range effort from Jordan Mutch gave Cardiff a glimmer of hope and Steven Caulker’s 73rd minute back-header from Gary Medel’s free-kick looked like leaving Mel waiting longer for that first home win. Thievy had other ideas, turning in Stephane Sessegnon’s deflected shot in injury time to spark wild celebrations on the home bench. But with referee Michael Oliver looking at his watch, there was still time for Wilfried Zaha to make inroads down the right and send in a cross from which Daehli grabbed another barely believable equaliser. At the end of the day a point was what neither side wanted after 90 minutes of high-octane and often kamikaze action. But it was a particularly crushing setback for the Baggies who looked set for a productive afternoon when Amalfitano, back in the side after two games out with a knee injury, spotted Cardiff keeper David Marshall off his line and lobbed home the opener from a tight angle on the right. It could have got even worse for the visitors in a torrid opening period, Marshall going some way to redeeming himself with a vital touch three minutes later to deny an almost certain second for Matej Vydra. With less than 10 minutes on the clock, Cardiff’s nightmare start was complete as Amalfitano sent in another superb ball from the right to Vydra, whose simple pass across the box was gleefully turned in by Dorrans. Substitute Mats Daehli snatched a potentially priceless point for Cardiff in a crazy finish to their Barclays Premier League relegation clash against West Brom, which ended 3-3 at The Hawthorns. Press Associationlast_img read more

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Mertesacker rues defensive errors

first_img The industry of the home side was rewarded when Harry Kane swept in an equaliser as he ghosted in unmarked at the far post when Arsenal failed to deal with a corner at the start of the second half. Just when it seemed Arsenal had done enough to maintain their recent unbeaten run, another lapse in concentration at the back allowed in-form Kane to get between Laurent Koscielny and Nacho Monreal to head home Nabil Bentaleb’s deep left-wing cross. Arsenal – who had won five successive matches ahead of Saturday’s poor display, including a battling victory at Manchester City – find themselves below Spurs in sixth place in the Barclays Premier League and must now regroup quickly for Tuesday night’s visit of bottom club Leicester to keep the pressure up on the top four. “We found a way recently to prepare ourselves on crosses better defensively (and also) on set-pieces, but we did not switch on quickly enough and were not up for proper defending, so that was worse than in recent weeks,” Mertesacker said on Arsenal Player. “We were not active enough and only started to play our game a bit towards the end, that took us too long. “When we had the ball, we could not find any solutions, they were always at us and we could not get the ball quickly in our own half so we could not hurt them on the counter-attack.” The German, who is captaining the side with midfielder Mikel Arteta still injured, added: “We have to analyse the problems they caused us, then we focus on Tuesday to bounce back from this setback as quickly as possible.” Gunners boss Arsene Wenger accepted his side paid a heavy price for “too many technical mistakes in the middle of the park” and was also less than impressed at the way Spurs crafted a late winner. The Gunners had looked set for another positive away performance when they snatched the lead through a fine volley from Mesut Ozil after 11 minutes. However, Spurs soon regained momentum as Arsenal struggled to deal with the impressive midfield work-rate from Mauricio Pochettino’s men. Per Mertesacker accepted Arsenal undid all of their recent good defensive work by not being “switched on” in allowing Tottenham to come from behind to win the north London derby 2-1 at White Hart Lane. He said: “(For the second goal) Kane had a completely free header in the box, with five minutes to go, that is difficult to understand with the experience we have at the back. “I am disappointed by the quality of our football and it was just not good enough.” Arsenal are expected to have leading scorer Alexis Sanchez back from a hamstring problem on Tuesday, while Theo Walcott is pressing for a recall having been left on the bench as fit-again Danny Welbeck started at White Hart Lane. Wenger maintains Leicester will be no pushovers, despite being rooted to the foot of the table after a third-straight league defeat when beaten 1-0 at home by Crystal Palace, if his team do not produce the required performance. “We play at home against Leicester, a team who fight not to go down,” said Wenger. “We have to recover from the disappointment and be ready to respond very quickly.” Press Associationlast_img read more

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Trojans leave Ojai with four Pac-10 titles

first_imgThe No. 5 USC men’s tennis team built upon its regular season Pac-10 title by capturing the Pac-10 championship team title along with three individual championships last weekend in Ojai, Calif.Champ · Senior Robert Farah won both the singles and doubles titles at the Pac-10 championships. Former Trojan Kaes Van’t Hof achieved the same feat in 2008. – Geo Tu | Daily Trojan Senior Robert Farah led the way by capturing both the Pac-10 singles championship and Pac-10 doubles championship with partner sophomore Steve Johnson.Farah followed in the footsteps of former doubles partner Kaes Van’t Hof, who won both the singles and doubles titles in 2008.“It’s a great achievement,” Farah said. “I was working for that; it was the ultimate goal. It feels awesome to do whatever Kaes did, and now I feel ready to play in the NCAAs.”In the doubles bracket, top-seeded Farah and Johnson triumphed over fourth-seeded Amit Inbar and Nick Meister of UCLA in straight sets, 6-3, 7-6 (4).The win helped Johnson overcome a personal barrier in the tournament and extended his winning streak when paired with Farah to 12.“Definitely enjoyable,” Johnson said. “I have lost twice in the final before. It feels good to finally get a win at Ojai.”Earlier in the day, top-seeded Farah defeated second-seeded Stanford Bradley Klahn 6-2, 7-6 (5) to capture the singles crown — his third singles victory over Klahn this season.As the top seed in the invitational bracket, Sundling stuck to the script and won 7-5, 7-6 over UCLA’s Alex Brigham.Sundling became the second straight Trojan to take the invitational singles crown after sophomore Daniel Nguyen achieved the feat last year.The top seeds were not the only Trojans to play well throughout the weekend.Four singles players and three doubles teams participated in respective championship brackets as well as four singles and two doubles inclusions in the invitational bracket.Apart from the champions, Nguyen and junior Peter Lucassen performed impressively in the competition’s top flight.“Nguyen was a couple of points away from a big win,” USC coach Peter Smith said of Nguyen’s three-set loss to Klahn in the semifinals.Lucassen dominated his two matches during the first day of play, including a win 6-1, 6-1 over sixth-seeded junior Jeevan Nedunchezhiyan of Washington.“Peter did have a good day, and this tournament is perfect for someone like Peter where he can get a little more comfortable of the tennis court and gain some confidence,” Smith said.In his following match, Lucassen fell short to Klahn but had the opportunity to build positive momentum following a tough stretch toward the end of the season.In another positive development, sophomore Matt Kecki returned to the courts for the first time since March 3, but he fell short 3-6, 6-2, 6-2 to Martin Kildahl of Washington.“Good to see Kecki back on the courts,” Smith said. “He had some flashes of great tennis but wasn’t fit enough to finish the match.”USC players said they are using this tournament as a building block for the upcoming NCAA championships and beyond.“I’m taking the tournament seriously this year,” Farah said. “Not that I did not take it seriously the last couple of years, but since I will be turning pro in June, these are the tournaments where I need to measure myself against the competition.”Planning for this tournament often relies on a delicate balance between resting players and having others participate to make sure the team is in top shape when the NCAA championships commence in mid-May.Johnson, junior Jaak Poldma, and senior Jason McNaughton took a break from singles play last weekend, but other regular contributors gained confidence in hopes of another championship run.“A couple of players were able to build momentum for the NCAAs,” Smith said. “That’s what we’re here for.”last_img read more