Hostname: page-component-5cf477f64f-mgq6s Total loading time: 0 Render date: 2025-04-02T09:06:09.921Z Has data issue: false hasContentIssue false
  • English
  • Français

Protecting the Frontline: Designing an Infection Prevention Platform for Preventing Emerging Respiratory Viral Illnesses in Healthcare Personnel

Published online by Cambridge University Press:  05 January 2015

Westyn Branch-Elliman ,
Connie Savor Price ,
Allison McGeer  and
Trish M. Perl
Westyn Branch-Elliman*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Eastern Colorado Veterans Affairs Healthcare System; Denver, Colorado Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
Connie Savor Price
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado Division of Infectious Diseases, Department of Medicine, Denver Health and Hospital, Denver, Colorado
Allison McGeer
Affiliation:
Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
*
Address correspondence to Westyn Branch-Elliman, MD, MMSc, Eastern Colorado Healthcare System, 1055 Clermont St, Mailstop 111L, Denver, CO ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Healthcare personnel often find themselves on the frontlines of any epidemic, and may be at particularly high risk of acquiring respiratory viral illnesses when compared to the general population. Many aspects dictate how respiratory viruses spread both inside the hospital and out: Elements to consider include the specific type of virus being targeted for prevention, as well as environmental conditions and host factors, such as age and immune status. Due to the diverse nature of these agents, multiple modes of transmission, including contact, droplet, aerosol, and transocular, must be considered when designing an effective infection prevention program. In this review, we examine the data behind current theories of respiratory virus transmission and key elements of any respiratory illness prevention program. We also highlight other influences that may come into play, such as the cost-effectiveness of choosing one respiratory protection strategy over another.

Infect Control Hosp Epidemiol 2014;00(0): 1–10

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 336 - 345
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.World Health Organization. Novel coronavirus infection in the United Kingdom. 2012. Available at: http://www.who.int/csr/don/2012_09_23/en/. Accessed July 8, 2014.Google Scholar
2.Bridges, CB, Kuehnert, MJ, Hall, CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003;37:1094–1101.Google Scholar
3.Hall, CB. The spread of influenza and other respiratory viruses: complexities and conjectures. Clin Infect Dis 2007;45:353–359.Google Scholar
4.Bischoff, WE, Reid, T, Russell, GB, Peters, TR. Transocular entry of seasonal influenza-attenuated virus aerosols and the efficacy of N95 respirators, surgical masks, and eye protection in humans. J Infect Dis 2011;204:193–199.Google Scholar
5.Centers for Disease Control and Prevention. Non-polio enterovirus. http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html. Published 2014. Accessed September 23, 2014.Google Scholar
6.Midgley, CM, Jackson, MA, Selvarangan, R, et al. Severe respiratory illness associated with enterovirus D68—Missouri and Illinois, 2014. MMWR Morb Mortal Wkly Rep 2014;63:798–799.Google Scholar
7.Sizun, J, Yu, MW, Talbot, PJ. Survival of human coronaviruses 229E and OC43 in suspension and after drying onsurfaces: a possible source of hospital-acquired infections. J Hosp Infect 2000;46:55–60.Google Scholar
8.Bean, B, Moore, BM, Sterner, B, Peterson, LR, Gerding, DN, Balfour, HH Jr.Survival of influenza viruses on environmental surfaces. J Infect Dis 1982;146:47–51.Google Scholar
9.Zaki, AM, van Boheemen, S, Bestebroer, TM, Osterhaus, AD, Fouchier, RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814–1820.CrossRefGoogle Scholar
10.Geller, C, Varbanov, M, Duval, RE. Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses 2012;4:3044–3068.CrossRefGoogle ScholarPubMed
11.van Doremalen, N, Bushmaker, T, Munster, VJ. Stability of Middle East respiratory syndrome coronavirus (MERS-CoV) under different environmental conditions. Euro Surveill 2013;18:20590.Google Scholar
12.Koster, F, Gouveia, K, Zhou, Y, et al. Exhaled aerosol transmission of pandemic and seasonal H1N1 influenza viruses in the ferret. PLoS ONE 2012;7:e33118.Google Scholar
13.Viboud, C, Alonso, WJ, Simonsen, L. Influenza in tropical regions. PLoS Med 2006;3:e89.Google Scholar
14.Lowen, A, Palese, P. Transmission of influenza virus in temperate zones is predominantly by aerosol, in the tropics by contact: a hypothesis. PLoS Curr 2009;1:RRN1002.CrossRefGoogle ScholarPubMed
15.Memoli, MJ, Athota, R, Reed, S, et al. The natural history of influenza infection in the severely immunocompromised vs nonimmunocompromised hosts. Clin Infect Dis 2014;58:214–224.Google Scholar
16.Fielding, JE, Kelly, HA, Mercer, GN, Glass, K. Systematic review of influenza A(H1N1)pdm09 virus shedding: duration is affected by severity, but not age. Influenza Other Respir Viruses 2014;8:142–150.Google Scholar
17.Mailles, A, Blanckaert, K, Chaud, P, et al. First cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013. Euro Surveill 2013;18:20502.Google Scholar
18.Edwards, DA, Man, JC, Brand, P, et al. Inhaling to mitigate exhaled bioaerosols. Proc Soc Natl Acad Sci USA 2004;101:17383–17388.Google Scholar
19.Occupational Safety and Health Administration. OHSA technical manual. Available at: https://www.osha.gov/dts/osta/otm/otm_viii/otm_viii_2.html#2. Accessed June 10, 2014.Google Scholar
20.Berger, P. On the use of a mask in operating. Paper presented at: Surgical Society of Paris; February 22, 1899; Paris, France.Google Scholar
21.Lowry, HC. Some landmarks in surgical technique. Ulster Med J 1947;16:102–113.Google Scholar
22.Johnson, DF, Druce, JD, Birch, C, Grayson, ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis 2009;49:275–277.Google Scholar
23.Stanley, WM. The size of influenza virus. J Exp Med 1944;79:267–283.Google Scholar
24.Yang, S, Lee, GW, Chen, CM, Wu, CC, Yu, KP. The size and concentration of droplets generated by coughing in human subjects. J Aerosol Med 2007;20:484–494.Google Scholar
25.Lee, SA, Grinshpun, SA, Reponen, T. Respiratory performance offered by N95 respirators and surgical masks: human subject evaluation with NaCl aerosol representing bacterial and viral particle size range. Ann Occup Hyg 2008;52:177–185.Google Scholar
26.Balazy, A, Toivola, M, Reponen, T, Podgorski, A, Zimmer, A, Grinshpun, SA. Manikin-based performance evaluation of N95 filtering-facepiece respirators challenged with nanoparticles. Ann Occup Hyg 2006;50:259–269.Google Scholar
27.Balazy, A, Toivola, M, Adhikari, A, Sivasubramani, SK, Reponen, T, Grinshpun, SA. Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks? Am J Infect Control 2006;34:51–57.Google Scholar
28.Makison Booth, C, Clayton, M, Crook, B, Gawn, JM. Effectiveness of surgical masks against influenza bioaerosols. J Hosp Infect 2013;84(1):22–26.Google Scholar
29.Li, Y, Wong, T, Chung, J, et al. In vivo protective performance of N95 respirator and surgical facemask. Am J Ind Med 2006;49:1056–1065.CrossRefGoogle ScholarPubMed
30.Milton, DK, Fabian, MP, Cowling, BJ, Grantham, ML, McDevitt, JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog 2013;9:e1003205.CrossRefGoogle ScholarPubMed
31.MacIntyre, CR, Wang, Q, Cauchemez, S, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses 2011;5:170–179.Google Scholar
32.Seto, WH, Tsang, D, Yung, RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003;361:1519–1520.Google Scholar
33.Loeb, M, McGeer, A, Henry, B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis 2004;10:251–255.Google Scholar
34.Bin-Reza, F, Lopez Chavarrias, V, Nicoll, A, Chamberland, ME. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza Other Respir Viruses 2012;6:257–267.Google Scholar
35.Thompson, KA, Pappachan, JV, Bennett, AM, et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic—the risk of aerosol generation during medical procedures. PLoS ONE 2013;8:e56278.Google Scholar
36.Perl, TM. The Respiratory Protection Effectiveness Clinical Trial. 2010. Available at: http://clinicaltrials.gov/show/NCT01249625. Accessed May 19, 2014.Google Scholar
37.Loeb, M, Dafoe, N, Mahony, J, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA 2009;302:1865–1871.Google Scholar
38.MacIntyre, CR, Wang, Q, Rahman, B, et al. Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers. Prev Med 2014;62:1–7.Google Scholar
39.MacIntyre, CR, Wang, Q, Seale, H, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Respir Crit Care Med 2013;187:960–966.Google Scholar
40.Bessesen, MT, Savor Price, C, Simberkoff, M, Reich, NG, Pavia, AT, Radonovich, LJ. N95 respirators or surgical masks to protect healthcare workers against respiratory infections: are we there yet? Am J Respir Crit Care Med 2013;187:904–905.Google Scholar
41.Jefferson, T, Del Mar, CB, Dooley, L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2011:CD006207.Google Scholar
42.Hashikura, M, Kizu, J. Stockpile of personal protective equipment in hospital settings: preparedness for influenza pandemics. Am J Infect Control 2009;37:703–707.CrossRefGoogle ScholarPubMed
43.American Hospitals Association. Fast facts on US hospitals. Available at: http://www.aha.org/research/rc/stat-studies/fast-facts.shtml. Accessed June 3, 2014.Google Scholar
44.Buxton Bridges, C, Katz, JM, Seto, WH, et al. Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong. J Infect Dis 2000;181:344–348.Google Scholar
45.Akazawa, M, Sindelar, JL, Paltiel, AD. Economic costs of influenza-related work absenteeism. Value Health 2003;6:107–115.Google Scholar
46.Centers for Disease Control and Prevention. Prevention strategies for seasonal influenza in healthcare settings. Available at: http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Accessed June 5, 2014.Google Scholar
47.Fisher, EM, Noti, JD, Lindsley, WG, Blachere, FM, Shaffer, RE. Validation and application of models to predict facemask influenza contamination in healthcare settings. Risk Anal 2014;34:1423–1434.Google Scholar
48.Grayson, ML, Melvani, S, Druce, J, et al.Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis 2009;48:285–291.Google Scholar
49.Aiello, AE, Coulborn, RM, Perez, V, Larson, EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 2008;98:1372–1381.Google Scholar
50.Wong, VW, Cowling, BJ, Aiello, AE. Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis. Epidemiol Infect 2014;142:922–932.Google Scholar
51.Talaat, M, Afifi, S, Dueger, E, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis 2011;17:619–625.Google Scholar
52.Aiello, AE, Murray, GF, Perez, V, et al. Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. J Infect Dis 2010;201:491–498.Google Scholar
53.Cowling, BJ, Chan, KH, Fang, VJ, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann intern Med 2009;151:437–446.Google Scholar
54.Suess, T, Remschmidt, C, Schink, SB, et al. The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC Infect Dis 2012;12:26.Google Scholar
55.Blumberg, HM, Watkins, DL, Berschling, JD, et al. Preventing the nosocomial transmission of tuberculosis. Ann intern Med 1995;122:658–663.Google Scholar
56.Gu, Y, Komiya, N, Kamiya, H, Yasui, Y, Taniguchi, K, Okabe, N. Pandemic (H1N1) 2009 transmission during presymptomatic phase, Japan. Emerg Infect Dis 2011;17:1737–1739.Google Scholar
57.Lau, LL, Cowling, BJ, Fang, VJ, et al. Viral shedding and clinical illness in naturally acquired influenza virus infections. J Infect Dis 2010;201:1509–1516.Google Scholar
58.International Society for Respiratory Protection. Selection, use, and care of respirators. Available at: http://www.isrp.com/americas/docs/st_paul_2011/mehes_use_care_standard.pdf. Published 2011. Accessed September 23, 2014.Google Scholar
59.Zhang, L, Peng, Z, Ou, J, et al. Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft, 2009. Emerg Infect Dis 2013;19. doi:10.3201/eid1909.121765Google Scholar
60.MacIntyre, CR, Cauchemez, S, Dwyer, DE, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis 2009;15:233–241.Google Scholar
61.Simmerman, JM, Suntarattiwong, P, Levy, J, et al. Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza Other Respir Viruses 2011;5:256–267.Google Scholar