| Hand Washing Conflicts Emerge
Regarding The Prevention of Flu
There’s no evidence that good hand hygiene practices prevent
influenza transmission, according to a Council of Canadian Academies
report commissioned by the Public Health Agency of Canada (PHAC).
But N95 particulate respirator-type masks are a proven "final
layer of protection" against even the smallest viral particles
of influenza, according to Influenza Transmission and the Role
of Personal Protective Respiratory Equipment: An Assessment of
the Evidence, a report prepared by an expert panel on influenza
and personal protective respiratory equipment chaired by Dr. Donald
Low, microbiologist-in-chief at Mount Sinai Hospital in Toronto,
Ontario (www.scienceadvice.ca/documents/(2007-12-19)_Influenza_PPRE_Final_Report.pdf).
Despite those 2007 findings, PHAC still recommends handwashing
as the primary preventive measure against flu transmission. The
agency also states on its website that there is no evidence that
wearing masks "will prevent the spread of infection in the
general population. Improper use of masks may in fact increase
the risk of infection."
Moreover, PHAC states in an email to CMAJ that "there is
substantial evidence to support hand hygiene as a basic premise
of infection prevention and control measures." The agency
also indicated that its hand hygiene recommendations are based
on a combination of expert opinion and evidence, including a recent
Cochrane Collaboration systematic review (BMJ 2009;339:b3675).
But the contradictory evidence and recommendations on preventive
measures and other pandemic (H1N1) 2009 issues leaves Canadian
doctors at a loss as to the best advice to provide patients, says
College of Family Physicians of Canada President Dr. Sarah Kredentser.
"The average family physician is confused and that’s
partly because there is a lot of conflicting evidence, and things
change day by day," Kredentser says, adding that there’s
a need for the experts to get the information right and then get
it out quickly to family physicians. To that end, the college
is now working with PHAC, the Canadian Medical Association and
other bodies to craft a one-page influenza guideline for physicians
to use in the community.
Reference Sources: cmaj.ca
November
11, 2009
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