Preventing Healthcare Workers From Acquiring Influenza

Abstract

Our survey of 133 on-duty medical ward nurses showed that, during peak influenza season, 30 (23%) developed an influenza-like illness, despite wearing a mask at work. Suboptimal adherence to standard precautions, such as the use of a face shield (odds ratio, 3.56) during high-risk procedures, and failure to receive influenza vaccination (odds ratio, 4.82) were independent risk factors, adjusted for household contacts.

Possible Role of Aerosol Transmission in a Hospital Outbreak of Influenza

“…The policy of isolating or cohorting patients with suspected or confirmed influenza is reinforced; application of an aerosol-generating procedure is allowed only in adequately ventilated single rooms before influenza can be excluded; all patients with respiratory infections are required to wear face masks, which are freely provided, until symptoms subside; air-conditioning units and their settings are regularly checked to avoid airflow imbalance; and HCWs are advised to use N-95 respirators, face shields, gloves, and gowns while performing aerosol-generating procedures and to receive annual influenza vaccines [2,5,8,9]. We have adopted these measures on all medical wards, because there might be similar unsuspected or "invisible" patients with influenza acting as infection sources.…”

“…PWH is a 1350-bed acute care general hospital operated by the Hospital Authority of Hong Kong that serves an urban population of 1.5 million. Each year, 1200 adult cases of confirmed influenza are being treated at PWH [5,21,22]. A major nosocomial outbreak of severe acute respiratory syndrome (SARS) occurred at PWH in 2003 [15,23]; since then, all patients hospitalized with acute febrile respiratory illnesses are put on droplet precautions; if influenza is confirmed, the patients will be isolated or cohorted in designated wards [21,22].…”

“…A major nosocomial outbreak of severe acute respiratory syndrome (SARS) occurred at PWH in 2003 [15,23]; since then, all patients hospitalized with acute febrile respiratory illnesses are put on droplet precautions; if influenza is confirmed, the patients will be isolated or cohorted in designated wards [21,22]. As a hospital policy, all health care personnel working in medical wards are required to wear surgical face masks, and an on-duty nursing officer is responsible for monitoring compliance [5].…”

“…Its consequences are considerable: it may result in significant disease and even fatality among hospitalized patients, because these patients often are older and/or have multiple comorbidities [1][2][3]. Health care professionals are frequently involved, and the affected hospital units may require temporary closure with service suspension [2][3][4][5][6]. Lack of preexisting immunity toward the recently emerged pandemic influenza H1N1 virus and its potential to cause serious disease in both young and older adults have further raised the importance of hospital infection control [7][8][9].…”

Guidelines in disrepute: a case study of influenza vaccination of healthcare workers

“…42 To support this recommendation, the authors cite studies examining: HCW attitudes to vaccination, 43 ethical issues associated with HCW vaccination 44,45 and risk of acquisition of influenza in non-vaccinated HCWs. 46,47 None of these studies could be considered to provide direct evidence for the value of HCW influenza vaccination in the protection of patients. However, if the value of vaccination as a public health tool is considered beyond question, reflecting a culturally shared belief, then the cited papers could be seen to provide background arguments for why HCWs should be targeted as a special case and for special measures.…”