Healthcare professionals work while sick despite risk to patients

[AussieNeil]

Hospitals are NOT good places to be if you have CLL, due to our compromised immune systems, though sometimes we have no choice. Here's another good reason to look after your health to hopefully avoid hospital admissions:

Results of a small survey showed that many healthcare professionals reported to work while sick, despite recognizing that this could put their patients at risk.

About 95% of survey respondents acknowledged that working while sick puts patients at risk, but 83% of respondents said they had worked while sick at least once in the past year.

About 9% of respondents reported working while sick at least 5 times.

Hematology Times (free membership)

hematologytimes.com/p_artic...

JAMA Pediatrics article:

archpedi.jamanetwork.com/ar...

Design, Setting, and Participants: We performed a mixed-methods analysis of a cross-sectional, anonymous survey administered from January 15 through March 20, 2014, in a large children’s hospital in Philadelphia, Pennsylvania. Data were analyzed from April 1 through June 1, 2014. The survey was administered to 459 attending physicians and 470 APCs, including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives.

The JAMA Editorial states:

For centuries, a guiding principle for health care workers (HCWs) has been primum non nocere, or first do no harm. Although this adage has been applied mostly to therapeutic interventions, it also infers that HCWs should not spread infections to their patients, especially the most vulnerable patients. However, HCWs do exactly that when they work with patients while ill themselves with contagious infections. A plethora of evidence suggests that HCWs can transmit a variety of infections to patients during routine clinical activities. Even common but untreatable infections like enterovirus and respiratory syncytial virus can prove deadly to immunocompromised patients. (My emphasis)

(You need a JAMA account to read both in full, but the article abstract tells you enough...)

Neil

[dwolden]

My husband's excellent internal medicine doctor ALWAYS advocated for us to get out of hospital asap in the several bouts of infection after chemo. He was very honest. "This is no place to be if you are sick."

[AussieNeil Partner Administrator in reply to dwolden]

My haematologist and doctors have said much the same to me and I'm pretty certain I picked up a gastro infection after a specialist visit - which is in a hospital .

[CClaver27]

Interesting. During my round 2 of FCR in APRIL, I developed a slight fever in the evening. It was high enough where I was required to call the doctor but not serious. That day, I remember the RN telling me whatever you do if you have any side effects do not go to the emergency room because they will hospitalize you. Call us first no matter the hour. The doctor who answered my call that evening put me on Cipro and again said don't go to the emergency room unless it really spikes over 103 but call me first. The reasons are obvious but during treatment hospitals that are not equipped to handle patients like us can be very risky.

[teragramb]

As with any job, hospital staff can run into difficulties with their employment if they take an excessive amount of time off sick. I have known staff who have been dismissed for that reason. They are not encouraged to take time off sick unless they have diarrhoea for example where they told they must stay off work for at least 48hours after the last episode.

[AussieNeil Partner Administrator in reply to teragramb]

This is a huge and growing problem, due to the casualisation of our workforce, with companies preferring to employ staff under part-time/contract conditions rather than on a full-time/permanent basis.

You could hope that enlightened management would appreciate that there needs to be more flexibility in the health care system for the good of their patients. Large hospitals would be better placed to be able to arrange for employees that are too ill to be near patients, but still able to work, to work temporarily in non-patient contact roles. The need for this has to become more important with the growing challenge we have from antibiotic resistance becoming more widespread.

Wouldn't it be good to have a hospital somewhere to take that initiative and publish a paper showing how they had considerably reduced nosocomial (hospital acquired) infection rates by proactively tackling this issue?

(Incidentally, I just checked I had the spelling and definition right for nosocomial and found these chilling words at the end of the page on nosocomial here: medicinenet.com/script/main...

"A bacterium named Clostridium difficile is now recognized as the chief cause of nosocomial diarrhea in the US and Europe. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics and may be acquired during hospitalization."

Neil

[Newdawn Administrator]

Teragramb makes a valid point. The sickness monitoring in the health and public care sectors in the UK can be quite draconian and the view taken is that frequent absences really don't have to be tolerated by the employer even if they are legitimate. Hence the infectious rampage of the mucous troopers who often feel they have little choice.

Last time I was in hospital I contracted an infection in my hand that was worse than the one I'd been admitted with!

Newdawn

[Peggy4]

Completely agree with Newdawn! Peggy.

[teragramb]

AussieNeil, I think you will find that there are veritable oceans of papers demonstrating how hospitals have reduced hospital acquired infections if you look in the trade journals e.g. Journal of Hospital Infection, American Journal of Infection Control to name but a couple. It is well recognised that poor hand hygiene is largely responsible for transferring infection between patients rather than a member of staff with a cold.

The idea of placing staff who are unwell in non-patient contact roles sounds ideal but I am not sure that such roles exist. Where they do, they require staff who are qualified to do the job such as Human Resources, Pathology laboratories and so on.

[AussieNeil Partner Administrator in reply to teragramb]

Improved hand hygiene is definitely the most effective way to reduce nosocomial infection rates, but even if hospital staff are excellent at that, you've still got the air infection pathway via coughing, sneezing and even just talking. Risks for us in particular may be greater with the not so obvious infections - the antibiotic resistant bacteria that are particularly challenging for us to overcome our compromised immunity, rather than respiratory or gastric illnesses.

While I'm not across the oceans of papers, I'm aware of the poor adherence to hand hygiene policy in hospitals world wide. Despite it being a 'simple' low cost solution, barriers to adherence are demonstrably hard to overcome. What's seen as 'good' hand hygiene practice in Australia is about 85% adherence. Some enlightened countries (like Australia ) actually publish the survey results for public hospitals on line. Australia has about 200,000 hospital acquired infections annually - for a population of just 23 million. That results in nearly 2 million additional days in hospital. That's a great deal of unnecessary pain, suffering, possibly permanent health impact, even death. Then there's the huge cost impact on society's quality of life due to patients having elective surgery deferred and funding being being diverted from other, more productive purposes to cover those 2 million extra patient days per year. As you point out, the major cause is due to the 'simple' lack of appropriate hand hygiene.

In Australia, with 85% hand hygiene adherence, on average every sixth interaction with a hospital employee in a well performing hospital is likely to be with someone who has not washed their hands before attending to you. Doctors (some actually acknowledge it) are considerably worse than nurses! (Per the article below, adherence used to be about 50% not that long ago and doctors back in 2012 had only improved to 62%...)

theconversation.com/washing...

healthunlocked.com/cllsuppo...

While I haven't had as many years of employment in hospitals as you, I have worked for a couple of years in contract work as an IT project manager for two major public hospitals with thousands of staff. My projects required me to work with anyone with a computer login, so I did get a reasonable overview of the entire operation. There are lots of non-patient roles, but no doubt far from sufficient to absorb employees that ideally should not be in contact with patients, plus you also have the departmental divides even if skills aren't an issue. As you point out, specialist roles can be a significant barrier, but there are usually projects in any department that get deferred due to lack of available resources and may not require specialist skills. The additional supervisory overhead for a few days effort in a non-patient role is also a big barrier.

You might hope that an employee that knows that they are sick and probably shouldn't be at work with patients will take extra care with hand hygiene, but would you bet your health on it?

Neil

[Cllcanada Top Poster CURE Hero]

Bit more on Medscape...

medscape.com/viewarticle/84...

[gisela1961]

I work in hospital daily 8hrs a day i have remained healthy and no health issues . I take care to wash hands often and hope i stay like this