Report: Health Care Workers In Peril

 

 

# 3027

 

 

As a former HCW (Health Care Worker), I have a special interest in the health and well being of those who will be on the front lines during the next pandemic.   For that reason, I’m always on the lookout for information about how they will (or won’t) be protected during a crisis.

 

Today we have a new survey that indicates that many healthcare facilities have done little to prepare for a pandemic.  The pdf file for the report is available at the link below:

 

Healthcare Workers In Peril:
Preparing To Protect Worker Health And Safety During Pandemic Influenza

A Union Survey Report
April 16, 2009

 

From the Executive Summary:

 

In an effort to assess the extent of employer efforts in planning adequate safety and health measures for healthcare workers, a group of unions developed a “pandemic flu preparedness survey” to assess the level of preparedness on a facility basis.

 

The survey as distributed to union leaders across the country who represent healthcare workers in unionized facilities. One hundred four (104) facility surveys were collected by six unions in fourteen states.

 

The results of the survey indicate that health care facilities have made some progress in preparing for an influenza pandemic but much more needs to be done.

 

More than one third of the respondents believe their workplace is either not ready or only slightly ready to address the health and safety needs necessary to protect healthcare workers during a pandemic.

 

Given this lack of readiness, 43 percent of respondents believe that most or some of their fellow workers will stay home.

 

One-third of the facilities have yet to develop a written plan for responding to pandemic flu and only 54 percent of the facilities have identified healthcare workers who will be at some risk of occupational exposure to the pandemic flu virus.

Less than half the facilities surveyed (43 percent) have provided pandemic flu training to their workers, one of the fundamental elements of protecting workers from occupational hazards.

 

 

 

Even among those facilities that do have a written plan (which in itself is no guarantee that they are prepared), 70% of the respondents stated that their union nor its members had any input into the plan.

 

 

The 14-page PDF file proposes a number of remedies, including urging that OSHA issue mandatory standards requiring that health care facilities protect all health care workers during a pandemic.

 

Right now, there are many pandemic recommendations from OSHA and the HHS, but most have no teeth.  Health care facilities are currently free to ignore them.

 

Nearly a year ago, the HHS released preliminary guidance urging hospitals to stockpile antivirals for their employees.   Anyone who would have direct contact with infected patients  would be considered `High Risk’, and `should' receive’ prophylactic tamiflu.

 

 

 

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).

 

 

A year later, very few hospitals appear to have made any provisions for prophylactic antivirals for their staff.

 

Even basic PPEs (personal protective equipment), like masks, gowns, and gloves will be in short supply during a pandemic, with few facilities having more than a few weeks supply on hand.  

 

Resupply, once a pandemic begins, will be doubtful at best.

 

OSHA estimate of PPE needs during a pandemic wave.

 

 

This general lack of preparedness on the part of healthcare facilities, and a failure of many of them to include HCW’s in the planning process, has resulted in a large number of HCW’s questioning whether they will risk working during a pandemic.

 

Poll after poll indicates that anywhere from 30% to 50% of HCWs would simply refuse to work during a severe pandemic – particularly if adequate PPEs and antivirals are unavailable.

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.

 

Another poll has been conducted on the Allnurses.com forum 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.

 

Nearly 1/3rd said they definitely wouldn’t work.  Another 20% weren’t sure.  I strongly urge all hospital administrators and nursing supervisors to read the 350+ comments that accompany this poll.   It makes for illuminating reading.

 

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.  

 

 

Health Care Facilities need to do a lot more to prepare for a pandemic, and they need to include their staff in the creation of these pandemic plans.  

 

Otherwise, they may well find that their most valuable resource will come up missing during the next pandemic crisis.