Doctor with TB exposes patients, co-workers
Doctor with TB exposes patients, co-workers
Case underscores risks of going to work while sick
For a few days last fall, a hospitalist in Duluth, MN, came to work with a lingering cough that he thought was a stubborn case of bronchitis. In fact, he had an active case of tuberculosis and had inadvertently exposed patients and co-workers.
Follow-up testing found no cases of transmission of TB at St. Mary’s Duluth Clinic among almost 200 people tested. But the case highlights the risks that can be posed when a health care worker comes to work sick.
Beyond employee education and an emphasis on the importance of good infection control practices, there is little a hospital can do to ensure that health care providers don’t come to work sick, employee health experts say. But this case, as well as the emergence of severe acute respiratory syndrome (SARS), underscores the importance of basic measures to prevent the spread of infectious diseases.
"I think it’s exceptionally difficult to get people to stay home when they’re ill, especially with the nursing shortage and the shortage of emergency physicians," says Sherri-Lynne Almeida, DrPH, RN, chief operating officer for Team Health Southwest, a hospital-based physician management company in Houston.
In fact, St. Mary’s reviewed its policies and decided not to make any changes. It already instructs employees not to show up for work sick with an infectious disease. "When you have health care workers who obviously are coming into close contact with people who are sick themselves and may be immunocompromised, people need to use good judgment and follow policies, which we do have," says Beth Johnson, spokeswoman for St. Mary’s. "People shouldn’t be coming to work sick. [But] physicians have such a strong work ethic, they really push themselves — in this case, obviously, when they shouldn’t."
When St. Mary’s hired Okwechukwu Iwu, MD, they knew he had contracted TB from working with AIDS and TB patients at another facility. In May 2001, he was diagnosed with a "presumptive" case of TB and put on a six-month regimen, which he completed. When he was hired at St. Mary’s that summer, a chest X-ray showed no evidence of TB.
Then, in November 2002, he developed a cough and began taking antibiotics. Two weeks later, he still had the cough. Believing that the prior treatment had cleared him of TB, "he had never even entertained the possibility of tuberculosis," says Johnson.
As soon as he was diagnosed, Iwu was placed in isolation in the hospital where he worked. His TB was identified as multidrug-resistant, and he has been treated with second-line medications that appear to be working.
"This has made our local hospitals really go back and look at their infection control policies," says Larry Sundberg, MPH, MBA, epidemiologist with the St. Louis County Public Health Department in Duluth. "One hospital went back to see if they have a Mantoux [testing] policy on their physicians. Others looked at policies about having people work sick."
There are actually many conditions that may make it unsafe or unwise for health care workers to come to work, notes Gabor Lantos, MD, PEng, MBA, president of Occupational Health Management Services in Toronto. What about someone with shingles? Or cold sores? Or even a noninfectious ailment such as vertigo? "The employee should go to occupational health and get a determination of fitness for health," Lantos says.
Supervisors need to be alert for signs of illness, and employees need to work in an environment where self-reporting is encouraged, says Lantos.
If employees come to work with respiratory symptoms — perhaps, because there are staffing shortages and they don’t want to impose on their colleagues — they should wear respiratory protection, Almeida says. That would involve either an N95 of powered air-purifying respirator, she says. "There are a lot of diseases as we now see that can spread quite rapidly."
For vulnerable patients, even common infectious diseases can be deadly. But ultimately, it is up to the employee to decide when to call in sick.
"At some point in time, it is a judgment call," says Johnson. "What is a cold? What is the flu? When are you contagious? "If there’s any silver lining to this situation, it was a learning experience for us. I think people are being more careful than ever. Hopefully, it won’t take something like that to keep us that way."
For a few days last fall, a hospitalist in Duluth, MN, came to work with a lingering cough that he thought was a stubborn case of bronchitis. In fact, he had an active case of tuberculosis and had inadvertently exposed patients and co-workers.Subscribe Now for Access
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