Infection: An Occupational Hazard for Healthcare Workers - Part 1

Given the massive infection crisis facing hospitals worldwide, protecting patients from pathogens is a critical priority.

But what about protecting staff?

Though patients, as a whole, are more vulnerable to infection than the healthy nurses, doctors, and aides who care for them, infection remains an occupational hazard for healthcare workers.

Influenza, norovirus, tuberculosis, Clostridium difficile: these are among the viral and bacterial illnesses that can and do strike healthcare workers — at tremendous cost to hospitals, patients, and the infected staff.

“Occupational infections, particularly hospital-acquired infections, are a serious problem in the healthcare industry worldwide,” a South African research team reported in the Global Journal of Health Science.

As German researchers have demonstrated, staff at the cleanest, most advanced European hospitals are not immune to viral and bacterial infections.

“Even though hygiene standards are high . . . in high-income countries like Germany, healthcare workers still remain vulnerable to infections at their workplaces,” concluded the Hamburg-based scientists.

Unsurprisingly, a report issued by the U.S. Centers for Disease Control and Prevention found that compared to employees in other occupations, healthcare workers are at higher risk for numerous infections — some transmitted via contaminated hands and surfaces, others spread by airborne particles.

The implications are clear: Hospitals must take more aggressive, innovative, and comprehensive action to keep employees healthy and performing at full capacity.

How Healthcare Workers Become Infected on the Job

It takes very little — a cough or sneeze during intubation or suctioning, for example — for hospital staff to become infected.

When a patient has the flu, simply talking or breathing can launch infectious particles airborne. These particles can travel across a room and hover for hours.

Norovirus is so potent that a single vomiting episode by an infected patient can release 13,000 particles of the virus; a healthcare worker can become infected by swallowing just 10 particles.

What’s more, airborne particles can land on nearby surfaces, such as exam tables, toilet handles, and doorknobs. “Norovirus can hang around for weeks, so anyone that touches that table and then puts their hand to their mouth could be at risk for infection,” says American microbiologist and norovirus researcher Lee-Ann Jaykus, PhD.

During norovirus outbreaks, hospital staff are more than twice as likely as other patients to become infected.

For example, when the virus struck two wards at an American hospital, 5% of patients in the coronary unit became infected, compared to 30% of the healthcare workers. In the psychiatry unit,16.7% of patients fell ill, compared to 38% of staff. Among the 105 infected healthcare workers, 13 affected required emergency department visits or hospitalization.

“Healthcare providers must understand that they can become contaminated by their patients and the environment near patients,” cautions Deverick Anderson, M.D., an infection-control expert at Duke University in the United States.

Though common viruses strike healthcare workers far more frequently than do antibiotic-resistant bacteria, staff can nonetheless become infected with the superbugs wreaking havoc at hospitals worldwide.

For example, Austrian epidemiologists reported on the case of a 24-year-old oncology nurse who developed severe diarrhoea after caring for three patients with symptomatic Clostridium difficile infection. The nurse, who was forced to go on sick leave, was infected with the same C. difficile strain as her patients.

“Not only laboratory staff but all health care workers are at increased risk of acquiring C. difficile infection,” the researchers concluded.

When Healthcare Workers Get Sick, Hospitals Pay

Infected healthcare workers are expensive for hospitals.

The American norovirus outbreak that struck 105 healthcare workers caused staffing shortages, restrictions on new patient admissions, and $650,000 in lost revenue.

An outbreak at a Swiss hospital — which struck 14% of patients but 30% of healthcare workers — also resulted in “significant” loss of revenue and sick-leave costs.

Flu-stricken employees are similarly costly. Over three flu seasons, one Italian hospital spent €1.7 million annually on expenses related to staff illness.

“An influenza epidemic accounts for thousands of days lost from work and causes substantial economic losses via healthcare worker sick days,” wrote the Torino-based researchers.

In addition, staff absenteeism can compromise both the quality of patient care and patient satisfaction.

When Sick Doctors Come to Work

Staff absenteeism is difficult enough for hospitals, but the alternative — presenteeism — can be worse. When ill staff members come to work, as they often do, they risk infecting patients and coworkers.

In a Norwegian survey of physicians, more than 50% admitted to having worked while infected.

And in a CDC study of nearly 2,000 healthcare workers, more than 40% reported coming to work with fever, sore throat, and other flu-like symptoms, a finding the lead researcher called “alarming.”

Also alarming: an American study that found 94% of workers at a long-term treatment facility reported working while ill; 8% reported vomiting on the job.

“Health care workers as a group are very likely to continue to work when infected with diseases despite the serious public health risks,” concluded the authors of “Presenteeism: A Public Health Hazard.”

A single infected nurse can put coworkers and patients at risk while generating media coverage that stokes fear among the public.

“Nurse With Tuberculosis May Have Exposed Over 1,000, Including 350 Infants” was the New York Times headline after a maternity-ward nurse was diagnosed with TB at a California hospital.

Read part two of this blog post here.