OSHA: Take steps now on pandemic protection
July 1, 2007 3 minutes read
OSHA: Take steps now on pandemic protection
PPE, planning will help ensure work force
In a pandemic influenza outbreak, your employees will be your most critical resource. That's why hospitals should act now to identify key personnel, provide employee training, and ensure the supply of adequate personal protective equipment, the U.S. Occupational Safety and Health Administration said in its Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers.
The 104-page document compiles information about influenza transmission and infection control, respiratory protection, and lessons learned from the SARS outbreak in Toronto in 2004. It draws from other U.S. Department of Health and Human Services pandemic preparedness plans in presenting the steps that hospitals should take to maintain their work force.
"It is only by protecting the skilled and dedicated employees working in health care that we may weather a pandemic," OSHA administrator Edwin Foulke said when the agency released the document.
Although H5N1 avian influenza has receded from the headlines, the threat has not dissipated. In May, the World Health Organization reported 15 new human cases in Indonesia, including 13 deaths. The virus now is responsible for 306 cases, involving 185 deaths, in 12 countries.
For many hospitals, the day-to-day challenges make it difficult to focus on pandemic preparedness. "It's a matter of juggling all the different priorities. It's not always easy to sustain your momentum," acknowledges Deborah Levy, PhD, MPH, senior adviser for health care preparedness with the Centers for Disease Control and Prevention in Atlanta and a captain in the U.S. Public Health Service.
Yet the importance of planning for the protection of health care workers recently was underscored in a survey conducted at St. John Hospital and Medical Center in Detroit. When doctors, nurses, and clerical and other workers were asked whether they would come to work if the hospital was treating patients with a pandemic-version of avian influenza, 42% said "maybe."
The biggest factor in their decision: "How confident I am that the hospital can protect me." For 18% of the respondents, financial incentives would not entice them to come to work — even if they were offered triple pay.1
St. John is now increasing its stockpile of protective equipment and revising its pandemic plan. Public health authorities in the southern region of Michigan are stockpiling enough antiviral medication to provide for family members of health care workers, says Charlene B. Irvin, MD, research director in the department of emergency medicine and associate professor at Wayne State University School of Medicine in Detroit.
"They told us they need to feel more protected," says Irvin. "We plan to start our educational program to let health care workers know what is the real risk if they use infection control measures and what [protective] measures will be in place. I think most health care workers would be surprised that we would have enough antivirals for them and their family members."
Hospitals must address the fears of health care workers, Irvin says. Surveys that ask whether they would report to work in a pandemic may actually underestimate the number who would stay away, she says. "It's much easier on a survey to be heroic and do the ethically responsible thing," she says.
Here are some key points about personal protective equipment (PPE) from the OSHA guidance:
- Hospitals should stockpile disposable respirators because a shortage of supplies is likely once a pandemic starts.
- Hospitals should consider purchasing elastomeric respirators for essential personnel. They can be decontaminated and reused if N95s are not available.
- Powered air-purifying respirators should be considered for essential personnel who will be wearing respirators for an extended time and may be involved in aerosol-generating procedures.
- If N95 respirators are in short supply, employees may reuse respirators that are not visibly soiled or damaged. Wearing a face shield may help prevent contamination of the outside of the respirator as long as the face shield doesn't interfere with the face seal of the respirator.
- There is no need to double-glove. Gloves may not be washed and reused.
- Gowns are not required for most routine patient care activities.
- Goggles and face shields should be used if a health care worker is within 3 feet of a coughing patient.
- PPE should be donned in the following order: gown, respirator (or mask, when appropriate), face shield or goggles, gloves.
- PPE should be removed in the following order: gloves, faceshield or goggles, gown and respirator or mask.
Reference
1. Irvin C, Cindrich L, Patterson L, et al. Hospital personnel response during a hypothetical influenza pandemic: Will they come to work? Acad Emerg Med 2007; 14(1):513.
In a pandemic influenza outbreak, your employees will be your most critical resource. That's why hospitals should act now to identify key personnel, provide employee training, and ensure the supply of adequate personal protective equipment.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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