NSC: Protecting Health Care Workers from the H1N1 Threat

At the National Safety Council (NSC) 2009 Congress and Expo, NIOSH Director John Howard stressed that in the face of the H1N1 pandemic, the perception that health care workers are self-sacrificial “saints” who inevitably place themselves at risk when they come to work must be discarded and that occupational safety and health principles must be applied to protect this working population.

“In a routine business, in a 2 trillion dollar industry, ‘saintly’ shouldn’t be the outlook,” Howard said, adding that a balance must be struck in protecting patients as well as the workers who care for them. “I think that working out the balance is possible in safety and health, but we need to pay more attention to that.”

Health care workers face a host of challenges, including lifting and exertion risks, interacting with difficult patients or family members and various health hazards that include, for example, a possible increased breast cancer risk in nurses working the night shift. While many of these hazards have been addressed, Howard said there is “one hazard frontier” left in health care – biological hazards – and health and safety professionally must become educated in this area.

“I would venture to say many of you have had [more] personal experience with many of the transmissible diseases in the workplace and handling health effects than you’ve had with some of the esoteric chemical and physical agents that you provide advice for every day of the week,” he said.

Now, with the H1N1 swine flu spreading throughout the world, the challenge is more present than ever. Addressing health care worker safety in the face of swine flu “requires the imposition and the awareness of basic occupational health and safety principals – looking at a hierarchy of controls, eliminating potential sources of exposure, taking steps to minimize risk,” Howard said. “It is absolutely critical for institutions to engage in this type of thinking.”

The Respirator Challenge

“CDC continues to recommend use of respiratory protection,” Howard said, referencing the Centers for Disease Control and Prevention (CDC) guidance on prevention and control for H1N1. “The basis for this recommendation continues to be unique circumstances with this pandemic: low immunity, especially in younger age groups; availability of vaccine (slow); the susceptibility of those in age range of health care workers, especially younger ones; and increased risk of complications once it’s acquired in those types of personnel. It’s an important issue that we base our recommendations on.”

The challenge, he continued, is the shortage of disposable N95 respirators. This year, with influenza levels in October matching typical levels in January or February, it’s clear there will be a gap in respirator availability.

To help work within the context of that shortage, NIOSH recommends that health care facilities implement a prioritized respirator use plan to ensure health care personnel most at risk will be able to use the respirators. In addition, every effort to obtain respirators should be documented in writing so the health care facility has a clear path to show they are operating in good faith.

“The question is why are we dong all this? Because some day, we may be facing a different type of pandemic,” Howard said. “That day may dawn on us and we need to deal with it now. Once this pandemic passes by, we need to leave ourselves better off than when it started.

“We cannot return to an era when health care professionals exposed to these diseases continue to be the norm, or that they agree to be at risk when employed,” he continued. “I think our attitudes, our policies, and our laws and our occupational health and safety practice needs to reflect this dual ethical imperative.”

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