Sick leave protects against flu spread
Sick leave protects against flu spread
CDC: Use masks, not N95s with H1N1
Masks are sufficient protection for health care workers involved in routine care of patients with H1N1, according to proposed new guidance from the Centers for Disease Control and Prevention. Preventing transmission also will depend upon vaccination of health care workers and policies that discourage employees from coming to work sick, the agency said.
This multi-dimensional strategy was well-received in the occupational health community, but with some reservations.
"It's important that protecting patients and protecting health care workers is a multifaceted process," says Mark Russi, MD, chair of the Medical Center Occupational Health section of the American College of Occupational and Environmental Medicine (ACOEM) and director of occupational health at Yale-New Haven Hospital. "The document did a nice job of giving good specific guidance about when [employees] should and shouldn't be in the workplace."
Yet monitoring the reason for health care worker absences can be challenging, especially for large hospitals or those that have a bank of leave days that can be used for either sick time or vacation, says William Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic in Rochester, MN. In fact, asking why they are out could be a violation of privacy of medical information, he says.
"How much medical information can the employer require the employee to disclose and how would you verify the information?" says Melanie Swift, MD, medical director of the Vanderbilt Occupational Health Clinic at Vanderbilt University in Nashville, TN, who notes that employees are also allowed to take paid time off to care for a sick family member.
"You can't require people to submit to a medical exam because they called in sick. Most are treated with self-care and don't need to see a provider," she says. "It's all on the honor system."
The employee health physicians agreed that the best approach is to educate health care workers about when to stay home and why it is an important aspect of patient safety.
"Ultimately, you've got to trust your workers to be honest and you have to have policies that don't punish them [for taking sick time]," says Swift.
Unions object to mask policy
Many employee health professionals expressed support for the CDC's proposal to scale back from N95 respirators to masks as protection for health care workers caring for patients with H1N1. The CDC noted that the H1N1 pandemic resulted in fewer hospitalizations and deaths than feared, and that a vaccination is now widely available.
Yet union leaders balked at the reduction in protection, especially since this flu strain caused severe illness in previously healthy adults and children. Bill Borwegen, MPH, health and safety director of the Service Employees International Union in Washington, DC, questioned CDC's emphasis on vaccination while it de-emphasized respiratory protection particularly since the H1N1 vaccine was determined to be just 62% effective.
"The imbalance of protection is really startling," he says. "[They] won't give health care workers a 50-cent, fitted N95 respirator when they go into a room with a coughing patient with suspected or confirmed H1N1."
CDC still recommends that health care workers use respiratory protection (an N95 respirator or higher) while performing aerosol-generating procedures, such as bronchoscopy, sputum induction, endotracheal intubation and extubation, open suctioning of airways, cardiopulmonary resuscitation, and autopsies.
High-risk employees may find themselves reassigned during community outbreaks. CDC stated that if health care workers "identify themselves as being at higher risk of complications, [of H1N1]" employers should "consider offering work accommodations to avoid potentially high-risk exposure scenarios, such as performing or assisting with aerosol-generating procedures on patients with suspected or confirmed influenza."
Masks are sufficient protection for health care workers involved in routine care of patients with H1N1, according to proposed new guidance from the Centers for Disease Control and Prevention. Preventing transmission also will depend upon vaccination of health care workers and policies that discourage employees from coming to work sick, the agency said.Subscribe Now for Access
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