And The New Survey Says . . .

# 2901

 

 

 

Over the past several years a number of polls, surveys, and studies have attempted to quantify just how many HCW’s (Health Care Workers) would choose not to work during an influenza pandemic.

 

The `official assumption’  is that up to 40% of hospital employees could be absent during the peak of a pandemic.  

 

This assumes that some HCW’s will be ill, and some would be home taking care of sick family members, while still others might choose not to work out of concern over their safety or the risks to their families.

 

Surveys and polls conducted both here in the United States, and around the world, call into question just how realistic this 40% absenteeism number really is.

 

Today, we look at a new study, this time out of Australia.  

 

(I’ve slightly reformatted the abstract and added some bolding to make it easier to read)

 

 

How would Australian hospital staff react to an avian influenza admission, or an influenza pandemic?

Authors: Martinese, Franco; Keijzers, Gerben; Grant, Steven; Lind, James

Source: Emergency Medicine Australasia, Volume 21, Number 1, February 2009 , pp. 12-24(13)

Abstract:

Objective:

To estimate the expected staff absentee rates and work attitudes in an Australian tertiary hospital workforce in two hypothetical scenarios: (i) a single admission of avian influenza; and (ii) multiple admissions of human pandemic influenza. Methods:

A survey conducted at hospital staff meetings between May and August 2006. Results:

 

Out of 570 questionnaires distributed, 560 were completed. For scenario one, 72 (13%) indicated that they would not attend work, and an additional 136 (25%) would only work provided that immunizations and/or antiviral medications were immediately available, so that up to 208 (38%) would not attend work.

 

For scenario two, 196 (36%) would not attend work, and an additional 95 (17%) would work only if immunizations and/or antiviral medications were immediately available, so that up to 291 (53%) staff would not attend work.

 

Staff whose work required them to be in the ED (odds ratios 2.2 and 1.6 for each scenario respectively) or on acute medical wards (odds ratios 2.2 and 2.0 respectively) were more likely to work.

 

Conclusion:

High absenteeism among hospital staff should be anticipated if patients are admitted with either avian or pandemic influenza, particularly if specific antiviral preventative measures are not immediately available.

Measures to maximize the safety of staff and their families would be important incentives to attend work.

Education on realistic level of risk from avian and pandemic influenza, as well as the effectiveness of basic infection control procedures and personal protective equipment, would be useful in improving willingness to work.

 

The results of this survey are in line with others conducted over the past three years. 

 

Last August we saw another survey out of Australia, this time of GP’s (General Practitioners), asking if they would  work during a pandemic (see Australia: Will Doctors Work In A Pandemic?)

 

 

How will Australian general practitioners respond to an influenza pandemic? A qualitative study of ethical values

 

Olga Anikeeva, Annette J Braunack-Mayer and Jackie M Street

Results:

Some participants felt they would not be able to cope with an influenza pandemic, while others felt it would simply mean an increase in their workloads.

 

Most respondents considered creating separate waiting rooms, moving the reception desk outside of the practice and delaying all non-urgent consultations in order to deal with a pandemic more effectively.

 

Respondents mentioned the conflict between their various roles and responsibilities as a primary source of tension when thinking about the way they would organise their work in the event of a pandemic.

 

A number of GPs said they would not practise in the event of a pandemic, as they felt their responsibility to their families outweighed that to their patients.

 

 

That (admittedly limited) survey indicated that 30% of GP’s might not work during a pandemic.

 

This comes out very close to the results seen in the Allnurses.com poll entitled: Nurses, would you go to work during a Pandemic?

 

 

The assumption for this poll is that a severe pandemic, with a high case fatality ratio and no effective vaccine, has broken out.

 

This poll has more than 1400 respondents.

 

Just as in the Australian study, better than 30% say `no’ outright, and less than 50% say `yes’.

 

The Allnurses poll also has more than 350 comments from HCW’s, and they should be required reading for every emergency manager, nursing supervisor, and hospital administrator.

 

 

The HHS document -  Home Health Care During An Influenza Pandemic : Issues and Resources – released last summer - covers a good many issues important to the Health Care sector, but none so important as anticipated employee absenteeism during a pandemic.

 

 

Willingness of Health Care Workers to Report to Work During a Pandemic

Research indicates a distinct difference between the concepts of ability to work and willingness to work, with the first referring to a worker's capability and the latter referring to a worker's attitudes and intentions regarding reporting to work.19

 

Surveys indicate that a significant number of health care workers may be unwilling to report to work during an infectious disease-related emergency.

 

The New York City survey cited above indicated that less than half (48 percent) of the workers would be willing to report to work during an infectious disease outbreak (see Figure 2).19

 

The most commonly cited reasons that workers gave for not being willing to respond to an emergency included fear and concern for their own and their families'  health and well-being (31.1 percent and 47.1 percent respectively).19

 

Figure 2. New York City Health Care Workers� Willingness to Report to Work, by Scenario

N = 6,428 health care workers in 47 facilities.

Source: Qureshi K, Gershon RRM, Sherman MF, Straub T, Gebbie E, McCollum M, Erwin MJ, Morse SS. Health care workers� ability and willingness to report to duty during catastrophic disasters. Journal of Urban Health. 2005;82(3):378�388.

 

 

Again, according to this study, the number of HCW’s willing to work during a pandemic appears to be less than 50%.

 

Repeatedly we see polls indicating that between 30% and 50% of HCW’s won’t be willing to work during a pandemic. 

 

 

When you add in the absenteeism due to illness, or caring for loved ones who might be ill, the 40% absenteeism estimate begins to look overly optimistic.

 

Additionally, non-medical hospital staff are almost never asked whether they will work during a pandemic, and yet their absence would have a direct and serious effect on the ability of any facility to deliver patient care.

Housekeeping, food service, laundry, security, lab, and even clerical are all critical areas, without which few facilities could operate for very long.  

 

 

Perhaps the greatest reason for this reluctance to work on the part of HCW’s is the perceived lack of action on the part of their employers to take steps to protect them and their families during an infectious disease outbreak.

 

 

 

OSHA (Occupational Safety & Health Administration) has released estimates on what quantity of PPE's healthcare workers would need over the period of a 12-week pandemic wave. 

 

 

Yet despite these recommendations, Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics recently released draft ethical pandemic guidelines on the rationing of scarce resources indicates that their are only enough PPE’s in the state of Minnesota to last 3 weeks into a pandemic.

 

It is likely that  most states would find themselves in a similar predicament, and resupply during a pandemic – when the whole world will be clamoring for PPE’s – is uncertain at best.

 

OSHA and the HHS have also issued strong recommendations that employers of high risk (mostly HCW) personnel stockpile prophylactic antivirals for their staff – yet few hospitals appear to have done so.

 

High Risk employees are defined by OSHA in their document Guidance on Preparing Workplaces for an Influenza Pandemic.

 

 

 

 

 

Very High Exposure Risk:

• Healthcare employees (for example, doctors, nurses, dentists) performing aerosol-generating procedures on known or suspected pandemic patients (for example, cough induction procedures, bronchoscopies, some dental procedures, or invasive specimen collection).
• Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients (for example, manipulating cultures from known or suspected pandemic influenza patients).

High Exposure Risk:

• Healthcare delivery and support staff exposed to known or suspected pandemic patients (for example, doctors, nurses, and other hospital staff that must enter patients' rooms).
• Medical transport of known or suspected pandemic patients in enclosed vehicles (for example, emergency medical technicians).
• Performing autopsies on known or suspected pandemic patients (for example, morgue and mortuary employees).

 

This decision chart on the issuance of prophylactic antivirals comes from the HHS document Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic.

 

 

 

 

 

So far, these are only recommendations. 

 

Strong recommendations, perhaps, but they do not carry the weight of law or regulation.  Employers are free to ignore them, and right now it appears that many are doing just that.

 

Hospitals and clinics (and first response outfits like Police, Fire, and EMS) that hope to maintain the maximum possible level of staffing during a pandemic need to seriously address the concerns of HCW’s, particularly when it comes to PPE’s and Antivirals.

 

Finding ways to protect and assist worker’s families should also be high on their list of priorities. 

 

Those who are willing to work on the front lines, and risk prolonged exposure to infectious patients, deserve the highest level of protection that can be reasonably provided.  

 

Even then, they will be doing a dangerous, exhausting, and extremely difficult job.  

 

Admittedly, a certain percentage of HCW’s will probably not work no matter what safeguards are afforded to them.  They may see the risks as being too high, or may feel their place is at home with their families.

 

But if we hope to maximize the number of people who will work, we need to seriously address the issues of their safety now. 

 

Excuses as to why employers failed to follow the HHS’s and OSHA’s recommendations on PPE’s and antivirals are unlikely to convince a good many HCW’s to work once a pandemic begins.