Death of nurse sets ominous pandemic tone
In an case that sets an ominous tone for the resurging pandemic, a healthy 51-year-old oncology nurse who worked in Carmichael, CA, recently died of a coinfection with H1N1 influenza A and methicillin-resistant Staphylococcus aureus. (MRSA).1 Karen Ann Hays, RN, died July 17 of a severe respiratory infection and pneumonia.
The source of infection was not reported, but both MRSA and H1N1 could have been acquired in the community or her hospital, Mercy San Juan Medical Center in Carmichael. The hospital did not return calls requesting comment, but MRSA is endemic in many health care facilities and also is spreading in the community. Similarly, H1N1 has been transmitted in both community and hospital settings.
The gravity of the situation gave a heightened urgency to a reinvigorated debate about H1N1 infection control measures. Though the circumstances of Hays' infections are not clear, a member of the California Nurses Association (CNA) cited her death at a recent Institute of Medicine (IOM) hearing on H1N1 respiratory protection issues. "Hays was a triathlete, skydiver, marathon runner, and a mom," said Bonnie Castillo, RN, director of government relations at the CNA. "She was also a member of our organization and became the first health care worker in California to die from the H1N1 flu."
Nurses took to the streets in the wake of Hays death, demanding transparency and accountability on infection prevention measures for health care workers in a protest organized by the CNA in Sacramento. The death puts a human face on the increasing concerns about worker protections against the first flu pandemic virus in 41 years.
"We filed a complaint with California's Division of Occupational Safety and Health after 10 registered nurses from a hospital in the San Francisco Bay Area were infected with H1N1 after being refused access to N95 respirators by the facility," Castillo said at the Aug. 13 IOM hearing. ". . . Surgical masks are not designed to protect health care workers from airborne transmission of disease, and do not provide the filtration levels that the N95 respirators offer."
Castillo also cited inconsistent facility policies and procedures on protection against H1N1. "In addition to these cases, preliminary findings from a nurses' survey of more than 75 hospitals throughout California, Illinois, Nevada, and Maine demonstrate disturbing gaps in hospital preparedness for responding to the H1N1 pandemic," she said.
The survey findings included:
- Nurses or other health care workers in over 12% of the hospitals have been infected.
- Nurses in more than 10% of the hospitals do not have access to N95 respirator masks.
- In more than a quarter of the hospitals, nurses have been expected to reuse masks, which is highly risky.
- In 20% of the hospitals, nurses say proper infection control procedures are not being followed.
- More than a third of the hospitals have failed to properly explain H1N1 flu policies to the RNs.
"In light of inconsistent facility policies, evidence of harm against RNs, and the impending onset of the influenza season, we cannot afford to rollback standards," Castillo testified. "We are at the onset of a global pandemic. The United States continues to report the largest number of novel H1N1 cases of any country worldwide."
The efficacy of the H1N1 vaccine is unknown, and may not be known until near the end of November, she stressed.
"While seasonal influenza may be dangerous for those over the age of 65, as well as those with chronic medical conditions, the H1N1 flu has proven to be deadly for all types and ages of people, including the healthy and active, such as nurse Karen Ann Hays," Castillo said.
Reference
- Dahlbert C. Swine flu fatal to local cancer nurse. Sacramento Bee. Ju1, 31, 2009. 1B. www.sacbee.com.
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