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Health care workers should take note of pandemic influenza planning
Unanswered questions of transmission, personal protection and hospital policy abound in pandemic influenza predictions.
Personal protection using surgical masks, N95 respirators and prophylaxis are among potential choices health care workers will need to make during an influenza pandemic; however, the logistics of taking these precautions still need to be worked out, according to a presentation at the 10th Conference of the International Society of Travel Medicine, held in Vancouver recently.
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“In terms of definition, pandemic flu does not necessarily mean Armageddon, and in terms of us ‘being due’ for a pandemic, it doesn’t work that way,” said Michael Gardam, MD, MSc, a professor of infectious disease at the University of Toronto. “There is no defined interim, such as 40 years, for a pandemic.”
Health care professionals must be considered because the overall health of the general population would depend on them during an influenza pandemic, according to Gardam.
Pandemic influenza targeted
Even during a moderate pandemic, plans for health care workers’ roles must be considered. They may not want to report to work during a pandemic without the proper equipment when facing contact risks.
In a survey, many health care professionals reported they would not report to work in a pandemic. During a real pandemic, an even larger portion of health care professionals would probably not work, according to Gardam.
“People aren’t supposed to die of infectious disease anymore. They die of cancer and heart disease and everything else, so when you get health care workers to work each day, they aren’t expecting to die of infectious disease in the workplace,” he said.
Mask efficacy undetermined
Plans for use of surgical masks or N95 respirators could be difficult, in part because of the many unknowns about influenza transmission. Greater emphasis should be placed on understanding transmission, perhaps through more studies or by considering older studies on influenza as a pathogen, Gardam said.
“This could have a huge impact on protecting health care workers,” Gardam said. “If you don’t know how it’s spread, we don’t know what we’re supposed to do or what we’re supposed to wear.”
Mask, gloves and gowns may be standard hospital protection, especially during an influenza pandemic, but the efficacy of these items is largely unproven, according to Gardam.
In the United States, the most recent CDC pandemic influenza guidelines recommend facemask use when people are within 15 feet of one another and respirator use for those in direct contact with influenza patients. In Canada, masks are not recommended at present because of concerns that efficacy is diminished by contamination when touching the mask for removal.
If respirators are recommended, hospitals and clinics must consider if and how they will provide them for health care workers; however, unions will likely demand the safety measures and will want to know whether workers will be able to use them properly long-term.
“One thing we learned during [the severe acute respiratory syndrome epidemic] was that wearing an N95 respirator for 12 hours a day for three months is physically difficult; people get headaches, they get confused and, if you spend the whole day in a mask, you can’t breathe,” Gardam said.
For more information:
- Gardam M, Pandemic influenza: Is it if or when? Presented at: The 10th Conference of the International Society of Travel Medicine; May 20-24, 2007; Vancouver.