Cal-OSHA: RN death not fully probed

Hospital cited in H1N1 investigation

The death of a nurse from the novel H1N1 and methicillin-resistant Staphylococcus aureus (MRSA) should have been more thoroughly investigated for a work-related link, according to the California Division of Occupational Safety and Health (Cal-OSHA).

California nurse Karen Ann Hays, RN, 51, a previously healthy triathlete, marathon runner and skydiver, came to the emergency department with severe respiratory symptoms on July 9, 2009. Less than two weeks later, on July 17, she became the first known health care worker to die of complications of H1N1. The death certificate also noted methicillin-resistant S. aureus (MRSA) infection as a contributing factor. Cal-OSHA cited Mercy San Juan Medical Center in Carmichael, CA, for failing to screen its employee sick calls to determine if the nurse may have had exposure from people other than immediate co-workers, such as environmental services workers, physicians, students or volunteers.

The hospital also looked only for cases of H1N1 among the nurse's patients and failed to look into H1N1 cases in her unit or in the hospital generally.

"They looked at patients to whom the nurse was clearly exposed, but they didn't look at all the potential sources of occupational H1N1 infection," says Deborah Gold, MPH, CIH, senior safety engineer in the research and standards health unit at Cal-OSHA in Oakland.

At the time, the H1N1 outbreak still was evolving in the community. The citation pertained to a California standard requiring employers to maintain an effective Injury and Illness Prevention Program. The Cal-OSHA citation also notes that the hospital did not investigate a potential occupational link for the nurse's MRSA and the hospital's MRSA program did not include a procedure to investigate occupational exposures.

"Because [hospitals are] a higher risk environment for MRSA, we do think that when employees have MRSA infections, health care employers should look at that as a potentially occupational infection," says Gold.

In a statement, Belva Snyder, RN, chief nurse executive of Mercy San Juan Medical Center, took issue with Cal-OSHA's conclusions and said the hospital will appeal the citation:

"The unfortunate death of one of our employees due to H1N1 was extremely unusual and devastating for the staff and physicians at Mercy San Juan Medical Center. Upon her sudden and serious illness, a physician specializing in infectious diseases and infection control nurses immediately launched a thorough investigation into the employee's work history to ensure there was no hospital-based or occupational hazard that caused an exposure to H1N1. We are confident in the findings of our investigation that our employee's H1N1 illness was not the result of workplace exposure to the virus."

Meanwhile, the National Institute for Occupational Safety and Health (NIOSH) decided not to probe the California case as it sought to investigate cases that were clearly occupationally linked. NIOSH has been working with state health departments to gauge the occupational link to novel H1N1 cases in health care that caused fatality or severe illness.

"We looked at a number of different cases that have been presented to us, but we haven't moved forward to a field investigation," says John Halpin, MD, MPH, medical officer in the NIOSH Emergency Preparedness and Response Office in Atlanta.