Health care workers infected with H1N1
One HCW reported transmission despite mask
With persistent outbreaks but milder than expected disease severity, the novel H1N1 posed a unique dilemma for health care providers. They first needed to assuage fear, then to prevent against complacency. They needed to monitor employee illnesses and provide adequate precautions, yet encountered varying guidance.
At least 100 health care workers were among the nation's confirmed and probable novel H1N1 cases identified by mid-May, according to the Centers for Disease Control and Prevention (CDC). It was not clear how many of them contracted the illness in the community and how many cases were work-related.
In Wisconsin, for example, nine health care workers contracted novel H1N1 from the state's first confirmed case in late April. "They had the patient in droplet precautions at that time. There were health care workers who were not using surgical masks when they went in to take care of the patient," says Gwen Borlaug, CIC, MPH, infection control epidemiologist with the Wisconsin Division of Public Health in Madison.
In one case, the health care worker reported that she wore a surgical mask and gloves at all times while caring for the patient, which might indicate that droplet precautions were not sufficient to protect against transmission, says Borlaug. "It's something we need to further investigate," she says.
Nationally, health care workers contracted novel H1N1 from their coworkers who came to work sick, says Daniel Jernigan, MD, PhD, deputy director of CDC's influenza division. "If [employees] are sick, they should stay home, not only to protect patients but also to protect other health care workers from getting ill as well," Jernigan says.
Meanwhile, the emergence and continued spread of the novel influenza virus caused confusion as health care providers sought to respond. Respiratory protection was a particular area of concern. Eric Toner, MD, senior associate in the Center for Biosecurity at the University of Pittsburgh Medical Center, says, "We heard of some hospitals that had a run on their N95 [respirators]. Clinical units were hoarding them to make sure they had enough."
Some hospitals gave health care workers prophylactic antiviral medication even if they were protected when they had contact with a single patient, Toner says. Another hospital asked its employees to wear N95s at all times, although no cases had been reported in the community, he says. "It was my understanding they reversed that [policy] pretty quickly," he says.
In other locales, hospitals were reluctant to provide employees with N95s, perhaps because they feared a shortage or additional expense, according to labor advocates for health care workers. At one hospital in New York state, for example, a nurse reported that nurses were told they could have only one N95 per shift. "They're not taking the threat seriously, and they're not thinking of the people at the bedside," said the nurse, who asked not to be identified.
CDC allows guidance 'flexibility'
While the CDC maintained its "interim" guidance for health care workers to wear N95s when caring for patients with the novel H1N1 virus, numerous state and local health departments developed their own, less stringent recommendations.
The CDC did not try to unify those disparate recommendations. "We allow for there to be some flexibility so that states can take into account the unique activities and the unique amount of disease . . . in their jurisdictions and come up with the appropriate guidance," Jernigan said at a media briefing.
Wisconsin stuck steadfastly with the CDC guidelines. Some studies indicate that influenza viral particles could be aerosolized, notes Borlaug. "We really don't want to transmit seasonal influenza or any kind of respiratory virus," she says. "We have to decide what is the best way [to protect health care workers] in the absence of a vaccine."
Labor advocates for health care workers decried the guidance that sanctioned surgical masks rather than respirators for those caring for patients infected with the novel virus. While the novel virus produced symptoms similar to seasonal flu, cases continued to grow in the late spring, a time when seasonal influenza usually wanes.
And unlike seasonal influenza, there is not yet a vaccine for the novel virus, notes Bill Borwegen, MPH, health and safety director for Service Employees International Union (SEIU) in Washington, DC. "It's an interesting juxtaposition because when there is a vaccine, people want to make it mandatory. But when there is no vaccine, people don't want to require respirators," he says.
With persistent outbreaks but milder than expected disease severity, the novel H1N1 posed a unique dilemma for health care providers. They first needed to assuage fear, then to prevent against complacency. They needed to monitor employee illnesses and provide adequate precautions, yet encountered varying guidance.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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