# 3362
Note: HCP’s are Health Care Professionals, which is sometimes used instead of the the older, and more familiar term HCW (Health Care Workers).
Over the past few weeks I’ve had an opportunity to speak with a number of nurses and techs who work at several Florida hospitals, and I’ve asked them what their hospitals have been telling them about Swine flu.
Most acted surprised, and said that their hospitals weren’t really saying anything about it. After all, it really isn’t any worse than regular flu . . .is it?
While these conversations can hardly be taken as a serious survey, when combined with today’s CDC teleconference, it may have been more telling than I realized.
According to today’s CDC’s MMWR (Morbidity and Mortality Weekly Report) (Volume 58, No. 23) hospitals aren’t doing enough to identify potential influenza cases, to isolate them, and to protect their staff.
Novel Influenza A (H1N1) Virus Infections Among Health-Care Personnel --- United States, April--May 2009
While this is early data, and limited to just a couple of dozen case studies, there is a disturbing trend here.
Of the 12 HCP with probable or possible patient to HCP acquisition, 11 reported information on their use of PPE when caring for the presumed source patient.
Only three reported always using either a surgical mask (two) or an N95 respirator (one) (Table 2). Five reported always using gloves. None reported always using eye protection. None reported always using gloves, gown, and either surgical mask or N95 respirator.
There’s a lot more there, so follow the link to read the study in its entirety.
This lack of diligence using PPE’s is remarkable, given that the cases studied occurred early in the outbreak, before we had any idea of the virulence of this virus.
A failure to take proper precautions not only puts the HCP at risk, it puts their patients and their co-workers at risk as well.
As easily transmissible as this virus appears to be, should HCP’s not adopt more stringent infection control, a great many will be at risk of illness this fall.
The CDC has this to say about appropriate protective measures to be taken in a health care setting:
Health care workers
All health care workers in direct patient care, including pregnant women, should follow standard precautions with all patients, regardless of infection status. (See Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers [PDF 689KB], page 15).
Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated (See Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers [PDF 689KB], pages 16-17).
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
- Endotracheal intubation
- Aerosolized or nebulized medication administration
- Diagnostic sputum induction
- Bronchoscopy
- Airway suctioning
- Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
- High-frequency oscillatory ventilation
Hospitals, and their in-service training people, along with infection control staff, need to begin taking this novel H1N1 virus seriously.
The `mild’ designation to this virus may have lulled some facilities into inattention.
There may also be some concerns among management about `making a big deal’ over this virus, for fears that some employees might not choose to work during a pandemic wave.
This would be penny wise and pound foolish if they begin to see serious absenteeism due to illness – much of which might have been prevented by taking proper precautions.
Many hospitals also seem to be ignoring the issue of PPE stockpiling, something that – with several months advance notice –isn’t going to be looked upon favorably by the staff if shortages occur in the fall.
Hospitals also need to consider their liability as well. From employees, and even patients.
A failure to observe the guidelines set forth by OSHA, the CDC, and the HHS during a pandemic (and make no mistake, this is a pandemic) engenders a lot of risk.
I am particularly concerned about the tens of thousands of pregnant nurses, doctors, and techs around the country.
The CDC suggests that reassignment to non-patient related activities be considered, or at the very least the of avoidance `high risk’ procedures.
I wonder how many Human Resources departments in hospitals around the country have already notified their staff of the CDC’s concerns, have stressed the need to use appropriate PPE’s, and have offered alternative job functions to those at greatest risk?
Damn few, I expect.
Our health care system stands to undergo a `stress test’ this fall, that if we aren’t careful, could bring some facilities to the breaking point. And that could endanger the lives of patients and staff.
The virus continues to circulate. This is not something we can `wait until fall’ to address. Hospitals need to be dealing with this now.
Not every risk can be avoided, of course.
But many can be reduced . . . if we take them seriously and act now.
If we fail do do so, however, the costs this fall could be enormous.
