ACOEM: Don't reassign all at-risk health workers
ACOEM: Don't reassign all at-risk health workers
ACOEM, IC groups fault CDC guidance
Occupational medicine physicians and infection preventionists agree: It isn't a good policy to exclude "at-risk" employees from certain duties due to potential exposure to novel H1N1.
The American College of Occupational and Environmental Medicine (ACOEM) joined with three infection control organizations - the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Infectious Diseases Society of America (IDSA) - to urge the Centers for Disease Control and Prevention to reconsider its guidance to reassign high-risk personnel so they don't provide care to patients with suspected or confirmed novel H1N1.
(ACOEM's logo also had erroneously been included on a SHEA media release that advocated the use of surgical masks rather than respirators when caring for novel H1N1 patients. ACOEM has not taken an official position on that issue. "The media statement cannot and should not be construed as ACOEM's position on respirator protection for HCWs exposed to H1N1 virus," an ACOEM spokesman said.)
In its interim guidance on facemask and respirator use (www.cdc.gov/h1n1flu/masks.htm), CDC states: "Because infection control precautions, including respiratory protection, are imperfect, workers who are at increased risk of severe illness from influenza, and who are caring for a patient with known, probable, or suspected novel H1N1 or ILI, may consider temporary reassignment to avoid exposure."
CDC also specifically recommends that pregnant health care workers "should consider reassignment to lower-risk activities, such as telephone triage. If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures: Endotracheal intubation, aerosolized or nebulized medication administration, diagnostic sputum induction, bronchoscopy, airway suctioning, positive-pressure ventilation via facemask (e.g., BiPAP and CPAP), and high-frequency oscillatory ventilation." (www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm.)
Generally, occupational health physicians oppose creating a policy that involves reassigning a category of workers. "The employer's job is to mitigate the risk," explains William Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic in Rochester, MN.
Such a policy also can add a layer of doubt and confusion. What if someone doesn't know she's pregnant? Or she's simply trying to get pregnant? What if he or she has asthma? Obesity also has been linked to a higher risk of complications from novel H1N1. Does that mean obese health care workers should be reassigned as well?
Buchta suggests considering employee concerns on an individual basis. "There are certainly individual cases that deserve attention and on a case-by-case basis, reassignment may be appropriate," he says.
Meanwhile, the National Institute for Occupational Safety and Health (NIOSH), which is a part of CDC, also is considering the issue of reassignment of employees due to the reproductive hazards associated with chemotherapeutic agents and hazardous drugs.
In a Federal Register notice (edocket.access.gpo.gov/2009/E9-22275.htm), NIOSH requested comment on the possible reproductive effects of hazardous drugs and alternative duty policies related to a couple trying to conceive and pregnant or breast-feeding women. An upcoming "Current Intelligence Bulletin" may address this issue, NIOSH said.
"We know that protection is not 100%. We know workplaces are contaminated, we know workers are exposed," says Thomas Connor, PhD, a research biologist at NIOSH in Cincinnati who specializes in chemotherapeutic agents and hazardous drugs. "Is that exposure harmful to the fetus, which is typically more sensitive to toxic injury?"
There are a number of sensitive issues involved with reassigning employees who handle hazardous drugs, including privacy, ethical, and financial issues, Connor acknowledged.
[Editor's note: NIOSH is accepting comments through Nov. 16 (NIOSH Docket No. 150) at [email protected], by fax to (513) 533-8285, or by mail to NIOSH Docket Office, Robert A. Taft Laboratories, MS-C34, 4676 Columbia Parkway, Cincinnati, OH 45226.]Occupational medicine physicians and infection preventionists agree: It isn't a good policy to exclude "at-risk" employees from certain duties due to potential exposure to novel H1N1.
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