Part II of a Two-Part Series: Fighting fear: Bioterrorism raises issue of prophylaxis
January 1, 2001 4 minutes read
Part II of a Two-Part Series
Fighting fear: Bioterrorism raises issue of prophylaxis
HCWs may need prophylaxis to feel protected
Imagine the ripple of fear that runs through a nursing unit when a patient turns up with bacterial meningitis, tuberculosis, or a little known infectious disease. Now magnify that many times over in the case of a bioterrorism attack, and you can understand why coping with fear may be one of the most important tasks of employee health professionals.
As hospitals create bioterrorism plans, they should consider the use of prophylaxis not just to prevent infection but to ensure the maintenance of the work force, bioterrorism experts say. Mean-while, how employee health professionals respond to health care workers’ everyday concerns about infectious diseases may lay the groundwork.
The creation of trust extends into everyday operations, as employee health professionals provide prompt and accurate information on infectious diseases to dissuade employees from having unnecessary prophylaxis.
"People get scared, and they start to consider the worst-case scenario," says Michael Bell, MD, bioepidemiologist for the Centers for Disease and Prevention’s Hospital Infections Program and lead CDC author of a guidance paper on bioterrorism.
But they need to balance that emotion with well-established facts. Standard precautions prevent transmission, whether with an outbreak of Ebola in Africa or endemic plague in California, he notes. Exposure requires close contact with infected patients, and prophylactic medications have side effects and risks of their own.
"Many times people who are merely in the same hallway [with an infected patient] will come to employee health and request to be prophylaxed," he says. "A lot of times what inflames that situation is mixed and incorrect information that circulates through the hospital."
An exercise in Denver revealed just how crippling fear could be in the event of a bioterrorism attack. In the scenario, scores of health care workers stayed home because they feared becoming infected or inadvertently infecting their family members. Planners decided that a portion of the available prophylactic medication would be reserved for health care workers, police officers, and other first responders and their families, just to reassure them enough to stay at work, says Stephen Cantrill, MD, associate director of emergency medicine at Denver Health Medical Center and a participant in the exercise.
"Health care workers were close to the top in terms of the groups you’re going to prophylax," says Cantrill. "If you lose the hospital staff, you lose your ability to treat anybody. You have to worry about the real threat, those who are at risk for infection, but there’s also the perceived threat. What percentage of your health care workers would show up for work once this became apparent? That’s a major issue. If all your health care workers stay at home, you become completely unable to operate."
Swift communication is critical, with specific information on the incubation period of the infectious disease and its treatment, says Tara O’Toole, MD, MPH, deputy director of the Center for Bio-defense Studies at Johns Hopkins University in Baltimore. Health care workers may feel reassured just to know that prophylactic medication is being made available for them, she says. "Scientifically there’s no question what the correct decision is, but that will be only one parameter of the decision-making process."
Hospital takes proactive approach
Responding to fear of infection is nothing new for employee health professionals, who get periodic requests for prophylaxis.
Dartmouth Hitchcock Medical Center in Lebanon, NH, takes a proactive approach, as infection control works with employee health to counsel employees who work in the area that treated a patient or patients with certain infectious diseases, such as meningococcal meningitis or tuberculosis. Staff ask detailed questions about exposure then explain what type of contact is necessary to put a health care worker at risk.
"If someone is insistent on taking chemoprophylaxis when it’s not appropriate, we spend a lot of time talking . . . about the side effects vs. the risk of their exposure," says Kathleen Golden McAndrew, MSN, ARNP, COHN-S, CCM, department director and nurse practitioner in the section of occupational medicine. "I think what people are looking for is the reassurance that they’re not going to develop the disease and pass it on to family members," she says.
Dartmouth keeps track of the exposure information in case occupational cases occur. "It helps us evaluate whether there was some kind of precautions we could have used with patients," she says. "Was this person put in isolation appropriately and within the right time frame? [Was he or she] masked? [Was the person] not masked when [he or she] should have been?"
Routine education isn’t enough to convey information about exposure and prophylaxis, says MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, executive president of the Association for Occupational Health Professionals in Health-care and employee health nurse practitioner at Sewickley (PA) Valley Hospital. "In every instance where this happens, you have to do a lot of education with the employees even if it’s something they’ve received training in," she says.
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