CDC: Health workers acquire H1N1 from unsuspected cases, lack of PPE
CDC: Health workers acquire H1N1 from unsuspected cases, lack of PPE
Poor compliance with recommended precautions
Health care workers contracted the novel H1N1 influenza A pandemic virus from undiagnosed patients with respiratory symptoms and from fellow employees who came to work sick. But even when they knew they were caring for patients with novel H1N1, many health care workers did not use all of the personal protective equipment [PPE] that is recommended.1
Those were the findings of an initial review of novel H1N1 cases among health care workers by the Centers for Disease Control and Prevention. In 11 cases of heath care workers who probably were or possibly infected through transmission from their patients, none had used all the recommended PPE. Only one health care worker, a physician, reported always wearing an N95 respirator when caring for novel H1N1 patients - and the infected physician had not been fit-tested.
CDC is conducting surveys to determine why health care workers are not wearing appropriate PPE - for example, if they are unaware of the recommendations, if PPE was not available, or if they believed they were not at risk of infection. The review of 11 cases showed that the health care workers rarely wore eye protection. Four reported that they never wore N95 respirators or surgical masks. Five did not even wear gloves.
"It is important to try to sort out the barriers to using the PPE, [to learn about] what is preventing workers from using it," says Alex Kallen, MD, MPH, medical officer in CDC's Division of Healthcare Quality Promotion (DHQP).
Yet clearly education is an important component, says Matt Wise, PhD, with the Epidemic Intelligence Service and DHQP. "Making sure all the people involved in that spectrum of care are getting the adequate training is really important," he says.
As of late June, 81 health care workers had been identified with novel H1N1. Many of them had acquired the disease in the community. In the first 26 cases analyzed, for example, only about 50% were linked to health care transmission.
"We are not seeing anything that would indicate that health care personnel are overly represented among the recognized cases in this country," says Michael Bell, MD, associate director for infection control in DHQP.
Many other health care workers received prophylactic antiviral medication after an exposure to a patient who was later diagnosed with novel H1N1. Yet many of those unprotected exposures in health care settings could have been avoided, says Bell.
"As we look through this information, one of the patterns that we're beginning to see is that health care facilities are not promptly identifying potentially infectious patients," he says. "That identification of potentially infectious patients as a first step is absolutely essential for [the precautions] to work."
Even in the summer, CDC reported continued outbreaks of H1N1 with pockets of transmission in certain parts of the United States. In the Southern Hemisphere, the novel H1N1 is spreading, as are the seasonal strains of influenza. "There is a potential for this fall that we might have multiple subtypes circulating," predicts Daniel Jernigan, MD, PhD, deputy director of CDC's influenza division.
That means that health care providers need to take precautions when caring for patients with febrile respiratory illness, says Wise. "Make sure you have a system in place to identify patients with influenza-like illness, and make sure you can put them in a place where they won't be exposing other patients or health care personnel," he says.
Meanwhile, health care workers themselves need to be more cautious about staying home if they're sick, says Kallen. The greatest viral shedding occurs the first few days after someone becomes symptomatic, he adds.
CDC also has detected clusters of transmission from health care workers who report to work even though they are sick. In one cluster in Ohio, a surgical resident exposed 166 health care workers; 113 of them received prophylactic Tamiflu.
"Health care facilities need to have appropriate leave policies in place, and health care personnel need to understand that they won't be penalized for using sick leave appropriately," says Bell. "Likewise, facilities use a large number of contractors, and those contractors also need to have appropriate sick leave policies."
When there is an exposure, adherence to the prophylactic regimen with Tamiflu also has been problematic because of side effects of nausea and diarrhea, Jernigan says. "Individuals have either declined altogether when offered, or have stopped their prophylactic treatment early because of those symptoms," he says.
Reference
1. Centers for Disease Control and Prevention. Novel influenza A (H1N1) virus infections among health-care personnel - United States, April-May 2009. MMWR 2009; 58:641-645.
Health care workers contracted the novel H1N1 influenza A pandemic virus from undiagnosed patients with respiratory symptoms and from fellow employees who came to work sick. But even when they knew they were caring for patients with novel H1N1, many health care workers did not use all of the personal protective equipment [PPE] that is recommended.Subscribe Now for Access
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