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Clarification Related to Facemasks and N-95 Respirators Related to H1N1 Influenza Virus

May 19, 2009

In response to questions that arose related to the use of surgical facemasks and N-95 respirators in the wake of the H1N1 outbreak, the following bullet points have been extracted by NASEMSO from multiple CDC and FDA guidance documents.
Several questions have arisen related to the use of surgical facemasks and N-95 respirators in the wake of the H1N1 outbreak. The following bullet points have been extracted by NASEMSO  from multiple CDC and FDA guidance documents for the convenience of our readers:

1. Based on currently available information, for non-healthcare settings where frequent exposures to persons with novel influenza A (H1N1) are unlikely, masks and respirators are not recommended.
2. All patients with acute febrile respiratory illness should wear a surgical mask, if tolerated by the patient. Persons who are ill with influenza-like symptoms should stay home and limit contact with others as much as possible. When not alone or in a public place, protect others by wearing facemasks (meaning surgical masks) to reduce the number of droplets coughed or sneezed into the air and the time spent in crowded settings should be as short as possible.
3. Respirators (meaning N-95 or higher filtering facepiece respirator certified by NIOSH) should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.
4. Pending clarification of transmission patterns for this virus, EMS personnel who are in close contact with patients with suspected or confirmed swine-origin influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gown, when coming into close contact with the patient.
5. All EMS personnel engaged in aerosol generating activities (e.g. endotracheal intubation, nebulizer treatment, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation) should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gown, unless EMS personnel are able to rule out acute febrile respiratory illness or travel to an endemic area in the patient being treated.
6. The FDA issued an Emergency Use Authorization (EUA) for N95 respirators on April 27, 2009. This EUA permits the deployment of these products, accompanied by fact sheets with information for use during the 2009 H1N1 flu virus emergency, from the Strategic National Stockpile for use by the general public to help reduce wearer exposure to airborne germs during this emergency. The specific products covered by the EUA are identified by manufacturer and model number (see http://www.fda.gov/cdrh/emergency/N95-authorization.html).
7. The term "general public" in this EUA is broad and includes people performing work-related duties, for example in occupational health care settings. However, this EUA does not affect Occupational Safety and Health Administration (OSHA) requirements. If respirators are used for people in occupational settings, employers must comply with the OSHA Respiratory Protection Standard, (29 CFR 1910.134), which can be found at http://www.OSHA.gov.
8. The EUA does not waive fit testing and other OSHA requirements that apply when respirators are used for people performing work-related duties.