By Bill Peckham
Last May the U.S. Department of Labor Occupational Safety & Health Administration (OSHA) released a proposed pandemic mask use and stockpiling guidance, CIDRAP had a good summary. This was used in dialysis pandemic planning circles to formulate plans that are now going into effect. The Kidney Community Emergency Response (KCER) Coalition Pandemic Preparedness Team's website links to the Summary of OSHA Respirator Requirements (PDF link). The OSHA endorsed KCER recommendation is for the patients to use surgical masks (OSHA calls these facemasks) and for staff to use disposable N-95 masks (OSHA calls these respirators).
Surgical masks do not offer the wearer reduce exposure to small inhalable particles, that's not their job. A surgical mask's job is to protect others, somewhat, from the wearer. The reason OSHA would like patients to wear surgical masks is to give staff an added layer of protection. It's not that the surgical masks will protect the patients from getting sick, it's that masked patients offer staff some level of protection from a communicable patient.
People on dialysis will be making their own calculation of risk as information comes in. Right now the news is only worrying if you think it represents the leading edge of a wave. If it does turn into an influenza wave then patients, in order to feel comfortable attending dialysis, will want some personal protective equipment - surgical masks don't do the job. The guidelines did not have the special circumstance of incenter dialysis in mind when they made their workforce-centric recommendations.
Patient use of N95 masks would increase patient safety and worker safety. Patients with the ability to purchase N95 masks should be told that it would be a good idea. Eventually people are going to learn that surgical masks don't offer protection, telling them now while Amazon.com has N95 masks in stock (as well as the more economically efficient and comfortable to wear reusable masks) is the right thing to do.
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