Infection control nurses criticise photo.

We found the article on norovirus in last month's edition of Kai Tiaki Nursing New Zealand (p1214), written by Christchurch Hospital nurse researcher Sandra Richardson, useful as an update for staff who may have to deal with this infection or find themselves involved in an outbreak.

It is worth pointing out, however, that the Christchurch Hospital infection control team does not advocate the use of the N95 masks as worn by the patient in the photo that accompanied this article. These masks are usually restricted to staff who are dealing with airborne infections such as pulmonary tuberculosis. In exceptional circumstances, such as severe acute respiratory syndrome, they may also be advocated. It is rarely necessary for patients to wear these masks, as they are designed to filter the air being inhaled. Hence, the only instance may be for patients who are very immuno-comproraised and require additional protection if outside a protective isolation environment.

If the photo was intended to support the article about norovirus, it may have been better to show the nurse wearing a surgical mask as it is the droplet risk to staff that is the main concern.

Jane Barnett, RN, MSc, Michelle Taylor, RN, BHSc, Karen Armstrong, RN

Injection Control Dept, Christchurch Hospital

Sandra Richardson replies: Thank you to the injection control staff for pointing out the difference relating to the appropriate masks for use with norovirus--this is a valid point.

The photo included with the article was taken in the corridor of Christchurch Hospital's emergency department, as a means of illustrating the practical difficulties associated with caring for patients with any potentially infectious disease in an open environment, where physical isolation is not always possible. The caption that accompanied the photo made that clear. It was not meant to be representative of specific norovirus care. This photo was taken with the patient's consent and represented actual practice at this time.