Is the Controversy Settled?
It is time to accept that many respiratory pathogens can be transmitted by aerosols and cause disease following inhalation, and it is time to implement the precautionary principle and determine PPE recommendations on the basis of this knowledge. As long as inhalation of aerosols is a possible mode of transmission for specific pathogens, the risk for such transmission exists and it should be acknowledged that HCP could become infected by this route.
The question then remains: Which pathogens, under which conditions, should require the use of respirators by HCP? As noted above, this could be determined by examining the transmission characteristics of the pathogen and the risk posed by the pathogen to HCP, acknowledging that the risk for infection will be greater if surgical masks are recommended for protection against pathogens transmitted by respiratory aerosols.
Much of the resistance to respirators is because they require fit-testing, are more expensive than surgical masks, and may be uncomfortable to wear. If demand is sufficient, more comfortable, easier to fit, and less expensive respirators can undoubtedly be designed.
The words of Justice Archie Campbell, author of Canada's SARS Commission Final Report should be remembered: "The point is not who is right and who is wrong about airborne transmission, nor is it how far large droplets travel. The point is not science, but safety. Scientific knowledge changes constantly. Yesterday's scientific dogma is today's discarded fable. When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even by the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty."
Harkening back to the words of Dr. Chapin, "Science can never be a closed book. It is like a tree, ever growing, ever reaching new heights. Occasionally, the lower branches, no longer giving nourishment to the tree, slough off. We should not be ashamed to change our methods; rather, we should be ashamed not to do so."
Medscape Infectious Diseases © 2011
Cite this: Kathleen H. Harriman, Lisa M. Brosseau. Controversy: Respiratory Protection for Healthcare Workers - Medscape - Apr 28, 2011.