Are your staff spreading disease to patients?
Flu vaccinations found to be effective
Chances are, your ED has isolation rooms for patients with contagious diseases, but patients also are at risk for contracting illness from your staff. Researchers recently found that health care workers have a much lower rate of absence from work than of febrile respiratory illness.1
"What that means is that people are coming to work with not only respiratory symptoms, they’re coming to work with fever and full-blown flu symptoms," says James Wilde, MD, FACEP, assistant professor of emergency medicine at the Medical College of Georgia in Augusta and the study’s principal investigator. "Then they are probably spreading it to patients and other personnel, which is not good."
Your staff also are at high risk for contracting flu from patients. "Half the patients we see in the ED have respiratory illnesses, even in the summertime. So we are likely to get flu, which is a highly contagious disease," he says. In turn, ED staff may come to work ill and spread flu to patients and colleagues, he adds.
Vaccine given to hospital staff
Those findings were part of a study on the effectiveness of flu vaccine on health care workers, which was conducted at two large teaching hospitals in Baltimore. The study found that the influenza vaccine for health care workers was effective in cutting down on contracting flu and severe respiratory disease, which can be spread to colleagues and patients. "There is no strong data supporting the use of influenza vaccine in healthy adults, and even fewer studies in health care workers. That’s why we did the study," says Wilde.
The flu vaccine was 88% effective in preventing influenza type A infection and 89% effective in preventing influenza type B infection, compared to the placebo group. Health care workers who were vaccinated became infected at much lower rates than those who received a placebo vaccine.
According to the study, vaccinations could result in a significant reduction in staff absences. The flu vaccine reduced the number of days absent from work by 53% and reduced the number of days of respiratory illness accompanied by fever by 29%.
Influenza infection was linked with an additional 1.5 days of febrile respiratory illness and 0.5 days of absence from work.
"The numbers are relatively small, but they do show a trend which is important," Wilde reports. "A staff member cutting down on one day of illness per winter doesn’t sound like that big a deal. But consider that you can cut down on that for a quarter of your personnel."
Even a small number of absences can affect your ED significantly. "Most EDs are lean and mean, without a lot of fat. So if you have a couple of personnel out for influenza, it’s not a minor point," says Wilde.
EDs should consider a policy stating that all employees who come in contact with severely ill or debilitated patients should get an influenza vaccine, he suggests. "There are a lot of respiratory viruses that circulate during the flu season, beyond influenza itself. Those viruses in general are not necessarily as dangerous to a compromised patient as flu. If you can at least protect people from the most severe respiratory illnesses, you have done something."
If ED staff stayed home every time they had a runny nose or cough, hospitals wouldn’t be staffed during the winter season, Wilde says. "But flu is much more severe and much more likely to cause fever. If you vaccinate your personnel with influenza vaccine, you can at least cut down significantly on the rate of that infection in those people. That will decrease the risk of spreading to patients or personnel."
Liability risks are another concern. "I wonder sometimes about potential liability a hospital could face if a slick lawyer was able to prove his client had a bad outcome from nosocomial flu," he says. "Especially if the hospital had no vaccination policy, it could be a problem."
Revenues also may be affected if patients contract influenza in the hospital. "If somebody gets sick from a nosocomial infection, most third-party payers will not pay for that extended stay in the hospital. It is not covered, and the hospital has to eat the cost," Wilde says. "That’s why most hospitals are taking great pains to prevent croup, influenza, chicken pox, and other highly contagious viral or bacterial infections."
Because the ED has such a high volume of patients compared with other departments, staff are exposed to people with influenza at a much higher rate. "It makes sense that ED staff should get vaccinated. Because even if we don’t pass it on to a critically ill ICU patient, we may pass it on to any patient that comes through our doors," he says.
Reference
1. Wilde JA, McMillan JA, Serwint J, et al. Effectiveness of influenza vaccine in health care professionals. JAMA 1999; 281: 908-913.
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