Clusters of worker illness may be unrelated, but investigation needed to make the call
‘Don’t solve the problem until you know what [it] is — whether it even exists’
Many hospital employee health directors have encountered the occasional report that a number of employees have gotten sick and there might be something in the work environment causing it. With media reports over the years of sick building syndrome and cancer clusters, people are alert to anecdotal reports that suggest such a trend.
For instance, a hospital director might have people call to say they’ve heard of five people diagnosed with breast cancer within the last six months. In a health system with more than 1,000 employees, this is not out of the ordinary, says Nicole Shaffer, DNP, CRNP-BC, COHN-S, director of occupational health and wellness at Pfizer in Lititz, PA. Shaffer will speak about this topic at the American Association of Occupational Health Nurses (AAOHN) 2015 conference, which will convene in Boston on March 23-26, 2015.
“I use that example because one in seven women will develop breast cancer, and when it’s in a close setting like that, people automatically assume it has to be something happening in the workplace,” she explains. “So how do we prepare for when people come in with these concerns; what do we say and not say?”
Shaffer suggests employee health directors establish a process for investigating workplace reports of illness clusters. Here are her suggestions for how to handle potential cluster illness investigations:
- Listen without exhibiting emotion.
“When people come to you with these concerns, you cannot respond emotionally,” Shaffer says. “Listen to what they’re saying and be objective because even an inappropriate nod of the head can give them the wrong message.”
An empathetic head nod might suggest the employee health director agrees with the complainant’s assessment of the situation or that there really is a problem.
“Talk about their concern, but don’t try to provide them with answers right away,” Shaffer says. “Thank them for raising the concern and tell them you will look into the concern.”
- Involve experts and staff appropriate to the question raised.
“Gather your thoughts and make sure the appropriate people are involved, including an epidemiologist, an environmental health and safety director, a safety office — depending on the complaint,” she says.
If the reported cluster involves staff working within one area or section of a hospital, the investigation might require an epidemiologist and experts who could answer questions about the type of medications they were handling or a hospital’s building and environmental staff to answer questions about potential mold or other allergens in that area.
Others who should be involved in the case are the hospital’s legal representation and human resources.
- Gather facts and evaluate.
“Don’t solve the problem until you know what the problem is and whether it even exists,” Shaffer says. “Identify who might be involved and who may be exposed.”
If three employees came forward with concerns about a cluster of illnesses, this could mean there are only three people involved or that more employees are impacted. The employee health director won’t know the scope of the problem until more facts are collected, she adds.
During the fact-collecting process, staff making the report and others identified as impacted by the possible illness cluster should be interviewed about their health.
“Ask what symptoms they’re having, what their job is, what areas they work in, and how long they’ve been there,” Shaffer says. “Learn more about their medical condition and from a medical practitioner, ask for a full detailed medical history.”
Sometimes the cluster complaint is raised by an employee who is not the impacted party. When a third party is making the complaint, the investigation should include an interview with that person to ask for a list of everyone the employee believes is affected, Shaffer suggests.
“We’ll listen to what the third party says, but I won’t ask a ton of health questions because that person is not the source,” she says. “We’ll encourage people to come forward if they have concerns about their health, and, in the meantime, I’ll pull health claims data.”
In the case of a cancer cluster concern, pulling health data from the past decade might be wise, she adds.
“We look at the entire facility to see how many claims of ‘X’ type of condition have happened,” she says. “How many employees have been treated for X and which departments do they work in?”
Once the facts are collected, the evaluation should take place. Employee health, a legal representative, an epidemiologist, human resources, senior management, and others might be involved with the evaluation.
Sometimes the findings will show that what appears to be a cluster is actually a series of unrelated events. For example, a reported cluster of miscarriages in a hospital might turn out to be a perception of a problem where none exists, particularly if the employees involved work in different areas and on different shifts. On the other hand, a cluster of miscarriages in one area, such as an oncology or radiation treatment area, might require further investigation and cellular pathology reports, Shaffer says.
Another situation in which an illness cluster might prove to be a true cluster involves molds and allergens. Shaffer has seen clusters traced to mold problems, including in carpets that may need to be replaced. In one case, a cluster of employees with allergy-like symptoms brought the carpet situation to the employer’s attention.
Stress can cause similar symptoms in workers, who may then be perceived as a cluster. “Stress is a very tricky one because it’s often difficult to prove that anyone is being treated differently than anybody else,” Shaffer says. “But if it’s all in one department then there has to be discussions, and this needs to be handled delicately.”
- Communicate findings.
A report of the findings will go to the hospital’s leadership. This should include a statement of the problem, description of the investigation, and an evaluation of the findings, Shaffer says.
The evaluation could describe national incidence rates for the diagnoses and compare these to site rates.
“In my experience, you do not provide the written report to the employees who asked the question about the cluster,” Shaffer notes. “Instead, we meet with them in person and give them verbal responses.”
The final report goes on file with the company, but communicating findings to employees should be done verbally to allow for open exchanges of communication, she says.
When the findings indicate that no cluster was found, the employee health director should explain the process, describing the review of medical claims data and industrial hygiene data, and saying that the organization has gone as far as it can.
“The more open you are about communication of the process, the better people will understand,” Shaffer says. “Explain the normal incident rate of the disease and how the cases in the organization are well within normal rates.”
Many hospital employee health directors have encountered the occasional report that a number of employees have gotten sick and there might be something in the work environment causing it. With media reports over the years of sick building syndrome and cancer clusters, people are alert to anecdotal reports that suggest such a trend.
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