H1N1 update; Healthcare Workers do not appear unusually infected...

Healthcare Workers do not appear unusually infected...

Another feature noted by scientists suggest that healthcare workers dealing with the H1N1 infection do not appear to he at higher risk of contracting the virus. See The CDC Morbidity and Mortality Weekly Report 19 June 2009:

Novel Influenza A (H1N1) Virus Infections Among Health-Care Personnel --- United States, April--May 2009

TABLE 1. Number and percentage of health-care personnel (N = 26) with confirmed or probable novel influenza A (H1N1) infection,* by selected characteristics --- United States, April--May 2009
Characteristic	No.	(%)†
Case status
Confirmed	18	(69)
Probable	8	(31)
Sex (n = 23)
Male	4	(17)
Female	19	(83)
Age group (yrs) (n = 20)
20--29	8	(40)
30--39	7	(35)
40--49	3	(15)
≥50	2	(10)
Race/Ethnicity (n = 22)
White, non-Hispanic	12	(55)
Hispanic	5	(23)
Black, non-Hispanic	2	(9)
Asian/Pacific Islander	2	(9)
Other	1	(5)
Job type (n = 25)
Registered nurse	5	(20)
Nursing assistant	4	(16)
Physician	4	(16)
Licensed practical nurse	2	(8)
Medical assistant	2	(8)
Physician's assistant	1	(4)
Nurse anesthetist	1	(4)
Orthodontic clincial assistant	1	(4)
Pharmacy technician	1	(4)
Physical therapist	1	(4)
Ward clerk	1	(4)
Student	1	(4)
Receptionist	1	(4)
Facility type§ (n = 25)
Outpatient	10	(40)
Inpatient, acute care	8	(32)
Long-term care facility/Long-term acute-care facility	2	(8)
Emergency department	2	(8)
None	3	(12)
* A confirmed case of novel influenza A (H1N1) virus infection was defined in a person with an influenza-like illness and laboratory-confirmed novel influenza A (H1N1) virus infection by real-time reverse transcription--polymerase chain reaction (rRT-PCR) or viral culture. A probable case was defined in a person with an influenza-like illness who was positive for influenza A, but negative for human H1 and H3 by influenza rRT-PCR. † Percentages in groupings might not add to 100% because of rounding. § Facility in which health-care personnel worked during the week preceding symptom onset.

TABLE 3. Use of personal protective equipment (PPE)* among health-care personnel (HCP) (n = 12) with probable or possible patient to HCP transmission of novel influenza A (H1N1) infection, by job type and facility type --- United States, April--May 2009
Job type	Transmission type†	Facility type	Gloves	Gown	Surgical mask	N95 respirator	Eye protection
Nursing assistant	Probable patient to HCP	Inpatient, acute care	Never	Never	Never	Never	Never
Medical assistant	Probable patient to HCP	Outpatient	Never	Never	Sometimes	Never	Never
Licensed practical nurse	Probable patient to HCP	Outpatient	Never	Never	Never	Never	Never
Physician's assistant	Probable patient to HCP	Outpatient	Always	Never	Never	Never	Never
Registered nurse	Probable patient to HCP	Outpatient	Never	Never	Sometimes	Never	Never
Nursing assistant	Possible patient to HCP	Inpatient, acute care	Always	Sometimes	Never	Sometimes	Never
Physician	Possible patient to HCP	Outpatient	Always	---§	---	Always	---
Licensed practical nurse	Possible patient to HCP	Inpatient, long-term care	Sometimes	Sometimes	Sometimes	Never	Never
Nurse anesthetist	Possible patient to HCP	Inpatient, acute care	Always	Sometimes	Always	Sometimes	Sometimes
Registered nurse	Possible patient to HCP	Inpatient, acute care	Always	Never	Always	Never	Never
Medical assistant	Possible patient to HCP	Outpatient	Never	Never	Never	Never	Never
Physician	Possible patient to HCP	Inpatient, acute care	---	---	---	---	---
* When with presumed source patient. † All exposures occurred ≤7 days before symptom onset. Probable patient to HCP transmission was defined as exposure to a patient with known novel influenza A (H1N1) virus infection without using a surgical mask or N95 respirator. Possible patient to HCP transmission was defined as exposure to a patient with known novel H1N1 virus infection while using a surgical mask or N95 respirator or exposure to a patient with respiratory illness (i.e., pneumonia, upper respiratory tract infections, or influenza-like illness) regardless of the use of respiratory PPE. § Information not available.

MMWR Editorial Note:

1. Routine infection-control recommendations to decrease the risk for transmission of seasonal influenza to HCP include vaccination, isolation of infected patients in single rooms, and use of standard precautions and droplet precautions.

2. For novel influenza A (H1N1) infections, CDC's interim infection-control recommends

a) the use of fit-tested N95 respirators, eye protection, and contact precautions in addition to routine infection-control practices applied to seasonal influenza;

b) that aerosol-generating procedures (e.g., bronchoscopy) should be performed in an airborne infection-isolation room with negative pressure air handling.

[11 Health Care Providers (HCP) were possibly infected because of probable patient to HCP transmission for whom adherence to these recommended practices were incomplete].

3. Barriers to adherence can include

1) a belief that these practices are not necessary, inconvenient, or disruptive;

2) lack of availability of PPE;

3) inadequate training in infection control;

4) failure to establish effective, systematic approaches to HCP safety; and

5) failure to recognize patients and activities that warrant specific infection-control practices.

4. Initial evidence suggests that HCP are not overrepresented among reported cases of persons infected with novel influenza A (H1N1) virus in the United States. Among confirmed and probable cases in adults aged 18-64 years and reported to CDC as of May 13, approximately 4% have occurred in HCP; approximately 9% of working adults in the United States are employed in health-care settings.

5. Whatever the risk for infection to HCP, much of that risk likely exists in the outpatient setting. As of May 31, only 653 (6%) of 10,053 patients reported with novel influenza A (H1N1) infection had been hospitalized. Many interactions between HCP and infected patients likely occur in ambulatory-care settings and highlight the need for outpatient staff members to follow infection-control recommendations.

6. Four limitations of this report:

First, the total number of infected HCP likely is underreported. Some HCP might not seek care for their symptoms; in addition, some states might not systematically collect data that allow them to identify HCP among persons with novel H1N1 infection.

Second, detailed risk factor information was available for only 26 (54%) of the 48 reported cases, some information was missing, and data were not collected on a number of infection-control practices, including hand hygiene.

Third, information collected on health-care and community exposures might have been subject to recall bias, and HCP might have had unrecognized exposures in either setting, which might have resulted in errors in identifying the source of acquisition.

Finally, conclusions in this report were limited by the small number of HCP cases available for analysis.

7. These results highlight the need to maintain adherence to comprehensive infection-control strategies to prevent transmission of novel H1N1 in health-care settings. These strategies should include administrative controls (e.g., visitor policies and triage of potentially infectious patients), provision of infection-control resources, training in infection-control practices and correct use of PPE, identification of all ill HCP, and exclusion of ill HCP from work.

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