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Page 1 of 2 10/7/14 Cjk(: 'Wq A L.. CUSTOMER NOTIFICATION FROM CROSSTEX: PLEASE DIRECT TO PRACTICE INFECTION CONTROL MANAGER AND/OR PRACTICE OWNER As a company dedicated to delivering infection control and prevention products and services,Crosstex is reaching out to customers and clinicians in order to address common incoming questions due to recent media attention surrounding viruses such as Enterovirus and Ebola. As it pertains to the Enterovirus,the CDC laid out the following information for healthcare professionals about the EV-D68 strain: There is no specific treatment for EV-1368 infections, according to the CDC,and there are no antiviral medications available either. To prevent the spread of infection,the CDC recommends washing hands with soap and water, avoiding touching eyes,nose and mouth with unwashed hands, avoiding kissing,hugging and sharing utensils with infected people and disinfecting frequently touched surfaces. • EV-1368 is a potential cause of clusters of severe respiratory illness,particularly in young children • Consider lab testing when the cause of infection for severely ill patients is unclear • Report clusters of severe respiratory illnesses to state and local health departments The CDC is working with the Colorado health department to investigate at least 10 cases of children who had a respiratory virus and then developed limb weakness or paralysis, according to Reuters. Of the 10,four tested positive for EV-1368,but all 10 had some form of enterovirus or rhinovirus. According to Anne Schuchat,MD,the assistant surgeon general, United States Public Health Service, and director,National Center for Immunization and Respiratory Diseases(NCIRD), "We really do think that clinicians throughout the country need to be on the alert for increases in severe respiratory illness and consider this in their differential diagnosis." Regarding appropriate face mask selection as it pertains to viral protection: The genus enterovirus has approximately 100 recognized types(1368 is one of them as is the common cold, rhinovirus)and these are among the smallest in size—approximately 0.03microns. As the enterovirus has an aerosol transmission,choosing a mask with the highest levels of filtration and fluid resistance is the logical decision. The ASTM Levels 2&3 for medical masks are identical for filtration percentages of BFE and PFE, however,Level 3 has a higher fluid resistance level. Crosstex recommends a face mask with ASTM Level 3 protection(the ULTRA®line). In addition clinicians must be reminded to change masks at optimal frequency(20 minutes aerosol procedures, 60 minutes non-aerosol, and at minimum after each patient)and are cautioned not to cross-contaminate clinician's hands or environmental surfaces by touching the front of masks during treatment,removal, or disposal.