Transmission of Influenza H1N1: What's Not Being Done
Transmission of Influenza H1N1: What's Not Being Done
Abstract & Commentary
By Leslie A. Hoffman, PhD, RN, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Dr. Hoffman reports no financial relationship to this field of study.
Synopsis: Less than one-third of health care workers with probable or possible patient-to-health-care-provider transmission of H1N1 reported consistently using a surgical mask or N95 respirator.
Source: Novel influenza A (H1N1) virus infections among health-care personnel — United States, April–May 2009. MMWR. Morb Mortal Wkly Rep 2009;58:641-645.
After identifying the first 2 cases of novel influenza (H1N1) infection in the United States in mid-April 2009, the Centers for Disease Control and Prevention (CDC) provided interim recommendations to reduce the risk of transmission in health care settings. To better understand the risk of health care providers (HCPs) becoming infected with H1N1 as a consequence of patient care and the impact of these recommendations, the CDC requested data regarding infected HCPs. As of May 13, 48 reports had been received; 26 included detailed information regarding risk factors that potentially led to the infection. Of those reporting H1N1 infection, 5 were RNs (20%), 4 were nursing assistants (16%), 4 were physicians (16%), and 12 were employed in multiple other occupations.
Of the 26 reports, 13 (50%) HCPs were deemed to have acquired H1N1 infection in a health care setting, including 12 instances of possible or probable patient-to-HCP transmission and one instance of possible or probable HCP-to-HCP transmission. The remaining 12 cases were attributed to transmission in the community (n = 11) or an unknown source (n = 2). Among those with possible or probable patient-to-HCP transmission, only 3 reported always using a surgical mask or an N95 respirator. The individual who reported using the N95 respirator also reported never having had a fit test and did not report information on gown or glove protection. Only 5 respondents reported always using gloves. None reported always using eye protection.
Commentary
Routine infection-control recommendations to minimize the risk of acquiring influenza include vaccination, patient isolation, and standard infection-control precautions. For H1N1, because of the lack of a vaccine and limited information regarding the severity and transmissibility, there were additional recommendations to use a fit-tested N95 respirator, eye protection, and contact precautions during patient care. Given the potential seriousness of infection with H1N1, it is disturbing that HCPs did not follow these guidelines. Although this report did not include information on why recommendations were not followed, similar behavior has been documented with regard to other infection-control measures, such as hand hygiene.
Many explanations have been offered for noncompliance, including the belief that infection-control practices are unnecessary or inconvenient, inadequate education, and failure to appreciate the significance of risk to self or patients. The report indicates that, of 3 HCPs who reported always using a surgical mask or an N95 respirator, 1 had not been fit-tested for the respirator and none used all the recommended personal protective equipment. These findings cannot confirm that patient-to-HCP transmission caused the reported infection or that findings would have been different if precautions were consistently followed. Although 50% of cases appeared to result from hospital-based sources, the remaining 50% appeared to result from community exposure. As the report notes, as of May 31, 2009, only 653 (6%) of 10,053 patients reported with H1N1 infection had been hospitalized.
Findings in this report are subject to several limitations. The number of cases may have been underreported and there is always potential recall bias. Detailed information was not available for all cases and the number available for analysis was small. Nevertheless, results highlight the need to reinforce the necessity to follow recommended guidelines, reinforce training, and be realistic about potential risk from not adhering to standard practices.
After identifying the first 2 cases of novel influenza (H1N1) infection in the United States in mid-April 2009, the Centers for Disease Control and Prevention (CDC) provided interim recommendations to reduce the risk of transmission in health care settings.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.