Infection Control & Hospital Epidemiology
Table 2. Summary of Issues and Examples of Clinical Conundrums and Practical Challenges Topic and Subtopic
Issues Lacking Guidance or No. Received Airborne infectious pathogens (n=18)
Emerging pathogens (novel or unknown pathogens)
1
How do you prepare for RP related to unknown or novel pathogens?
1
Where should healthcare organizations or staff go for advice regarding respiratory protection during outbreaks associated with novel pathogens?
Known pathogens sometimes requiring RP (eg, measles, zoster, influenza)
3
What is the preferred type of RP for HCW related to suspected measles? What RP should family members and visitors use? How is it affected by immune status?
Known pathogens for which there is a lack of scientific consensus on need for RP
Know pathogens always requiring respiratory protection (eg, TB, MERS, SARS)
2
Are respirators needed during podiatric procedures on patients with fungal infections on their foot?
1
If family member is the likely source of TB, what RP is required for protecting HCW from becoming exposed through contact with families?
Known pathogen not requiring respiratory protection
Procedure-related (n=13) Aerosol-generating procedures
Surgical smoke
Procedures performed in surgical suite
0 N/A 5
Should N95 respirators be used for influenza?
Guidance Conflicts (Conundrum) Example
479
Issues Causing Practical Challenges With Guidance (Operational)
No. Received Example
2
Are there situations in which aerosolization of norovirus occurs (eg, toilet flushing or violent vomiting)? Is RP needed?
2
In pediatric patients with TB, are the requirements different from adults?
1
What respiratory protection is needed for patients diagnosed with rhinovirus?
0 2 4 N/A
What is needed for laser procedures on patients with HPV?
How should one handle staff who fail N95 fit testing but need respiratory protection while maintaining a sterile surgical field (thus cannot use a PAPR)?
Procedures performed outside the surgical suite
Hazardous materials (n=13)
Hazardous medication aerosolization, compounding and/or administration
4
What type of RP is needed when compounding or administering hazardous drugs? USP requirements differ for whether the drugs are in powder (regular N95) or liquid form (surgical N95).
Handling and spill containment of hazardous medications
0 N/A 3
What RP is needed for staff working with Ribavirin, Gentamycin, Amikacin, Tobramycin, Amphotericin B? What about pediatric doses of ribavirin?
2
What do you do if the respirators in chemo spill kits are different from those respirators on which staff were fit tested?
(Continued) 2
What type of RP should be used in the MRI suite (especially when some have metal components)?
4 0 0
What RP is needed when performing bronchoscopies?
N/A N/A
1
What type of RP is needed for air medical transport staff?
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