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The Centers for Disease Control and Prevention (CDC) has updated its guidance on infection control measures for the H1N1 influenza virus in health care facilities, revising recommendations for the use of N95 respirators and the recommended time that health care personnel who develop fever and respiratory symptoms should be excluded from work, AHA News Now reports. The CDC continues to recommend that health care workers working in close contact with patients having suspected or confirmed H1N1 virus use N95 respirators. However, given ongoing shortages of respiratory protection equipment, the agency offers strategies to help facilities appropriately select and use respiratory protection, suggesting that facilities use source control, engineering and administrative measures to limit the number of employees exposed to patients with suspected or confirmed cases of H1N1. In addition, the agency suggests combining the use of triage procedures and partitions or other "engineering controls" to reduce exposures and proposes that facilities make efforts to reduce consumption or extend the use of N95 respirators or use alternative respiratory protection equipment for certain applications. In the event of a shortage of respiratory protection equipment, the CDC says that facilities should prioritize use for staff who are at most risk from H1N1 exposure, and suggests that facilities maintain a reserve "sufficient to meet estimated needs" for aerosol-generating procedures and for managing patients with other diseases that may require respiratory protection until supplies are replenished. In a supplement to its updated H1N1 infection-control guidelines, the CDC recommends steps that health care facilities may take in the event of shortages of respiratory protective equipment. For example, health care facilities may consider training staff to reuse N95 respirators or to visit multiple patients at once without removing the devices in between patient visits, although the agency notes that this may entail the risk of respirator contamination or contact transmission. Meanwhile, the CDC's updated guidance also suggests that health care personnel remain home from work for at least 24 hours after they no longer have a fever without the use of fever-reducing medication. The agency adds that facilities should ensure flexible and consistent sick leave policies, consider offering alternative work environments for high at-risk employees, and not require a physician's note to validate illness or return to work (AHA News Now, 10/14/09; CDC guidance, 10/14/09; CDC supplement, 10/14/09).