Will you work during a Pandemic?

[Goju]

admin note: we just added a poll to this thread today, april 25, 2008, please take a second and vote in the poll so we can have a graphical representation of the responses. thanks

scenario:

h5n1 (the bird flu) mutates to become efficient at transmitting human to human causing a pandemic, with a case fatality rate of 60% and with 80% of the cases in the 0-40 year old age range.

see:

http://www.wpro.who.int/nr/rdonlyres/fd4ac2fd-b7c8-4a13-a32c-6cf328a0c036/0/s4_1113.jpg

hospitals will be quickly overrun. hospital staff shortages are 50%. the government orders all nurses to work. there is not enough personal protection equipment (n95 masks, gloves, goggles, tamiflu, vax, etc)

home quarantines become common (in the fed plans).

your family is also quarantined in your home. you are running out of food and the government promises you will be "taken care of" if you report to work.

will you go?

[indigo girl]

Actually, after listening for two days to these panels, the conclusion that I am left with is that it was rather cowardly of the IOM not to let us hear the conclusion. We are not allowed to know how they voted. If they are making decisions for us, then they should have the decency to let us know who voted, how they voted and why. They are going to present their conclusions to CDC to recommend guidance, but we do not get to hear the conclusion. What's with that?

While there may be some non-compliance by some HCW in the workplace, I did not hear that it was a major cause of spread in the healthcare setting. What I did hear was that some HCW did not like using the N95 for a variety of reasons, comfort, interference with communication, and feeling isolated. These were actually cited as reasons to recommend using a surgical mask though most of the presenters agreed surgical masks were never designed to protect us from viruses. We heard that HCW coming to work sick and infecting others was a problem. I also got that the Canadian presenter, a PhD nurse, I think, justified the use of a lesser level of protection because most nurses would also be exposed in the community...So you give up protecting the HCW at work because they might get sick at home? What kind of logic is that?

What the panel was never able to provide was good evidence as to how influenza is transmitted, and Dr. Hodgson of the VA kept stresssing this. There is very little solid research on what happens exactly to cause transmission of influenza virus. It was very clear however, that the N95 is a lesser level of protection. He felt that not even the N95 was going to be a sufficient level of protection. A female clinician from Australia whose name I did not catch, felt that this virus is much more virulent than it is being portrayed, based on the cases that she has seen in her country.

Some on the panel frankly admitted that we will run out of N95 masks. Some felt that HCW should choose which mask fit their particular situation, which might not be unreasonable. For a noncoughing pt, or a one able to practice good cough etiquette, then it might be OK to use the surgical mask. For kids and noncompliant patients the N95 is better. Definitely for suctioning, and other invasive cough producing procedures, you would need the more protective N95 mask. You have to provide some options. Clearly the surgical mask is not going to be enough.

They also addressed the use of goggles and the possibility that flu can infect someone via the lacrimal duct to the respiratory tract if you do not wear eye protection such as a splash guard or goggles. No one argued about this, but some did question if there was evidence about this route of infection.

What I got out of these two days was that there was a clear need for more research but that there is no more time for this. The pandemic is here, and that everyone was concerned about the coming fall in the northern hemisphere.

There were many unanswered questions.

[Woodenpug, BSN]

Here is the link again to what the IOM actually discussed.

you'll see that non-compliance and improper use are the major issues.

http://www.iom.edu/CMS/3740/71769/71867.aspx

Rather than discouraging people about the potential lack of a possibly unnecessary piece of equipment, people interested in reducing the impact of pandemic flu should be encouraging universal precautions, cough etiquette and proper knowledge of equipment use.

Why is self-empowerment such a bad thing? Unions could promote those ideas and then have proof that unions work. (by showing a lower attack rate after the pandemic for union hospitals vs. non-union hospitals.)

[Laidback Al]

. . . Unions could promote those ideas and then have proof that unions work. (by showing a lower attack rate after the pandemic for union hospitals vs. non-union hospitals.)

After the pandemic is over the unions might just as easily show a higher morbidity and mortality rate for HCW who were not provided with adequate PPE.

[Woodenpug, BSN]

After the pandemic is over the unions might just as easily show a higher morbidity and mortality rate for HCW who were not provided with adequate PPE.

Yes. Most likely unions will increase the morbidity and mortality. Too bad, they can't escape their agenda and consider doing something effective.

[indigo girl]

There is no substitute for a clinical efficacy trial on what works and what does not.

The clincher for me was the presentation given on panel #3 by the Australian, Dr. McIntyre on a study done in conjunction with the Beijing CDC at 24 hospitals over there. The participants were docs and nurses that were issued either surgical masks, fitted N95 or nonfitted N95.

They found no clinical efficacy with the surgical masks.

However, with both fitted and nonfitted N95, there was proven clinical efficacy of:

60% for clinical respiratory illnesses, 75% of ILI illnesses, 56% of confirmed clinical respiratory viruses, and 75% of lab confirmed flu viruses.

Here is the audio link to the panel 3 presentations. She gives the second presentation.

http://www.iom.edu/Object.File/Master/72/403/Panel%203%20August%2012.MP3

[Woodenpug, BSN]

Dr. Mcintyre's main point was that lack of compliance greatly reduces efficacy. She chose china for her study because there mask wearing compliance is very high. In Australia compliance is less than 10%. Her first studies were comparing layered protection "surgical masks and hand hygiene education" to single intervention masks only with a no intervention control group.

Again the actual point, if one takes the time to listen to the entire audio tape, is that in western culture non-compliance and lack of education are the greatest cause of influenza spread.

You may use selective listening and/or editing to make any point. Still, many people will pay attention to the conference in its whole.

[indigo girl]

I am not disputing McIntyres other study on surgical masks and hand hygiene education with families.

My interest is in her study comparing the use of the N95 to the use of the surgical mask by HCW seeing patients in the hospitals. This research has direct relevance to our safety in the workplace.

Lack of compliance with using masks in Australia was the reason why she had to do this research in China. The Chinese work force is experienced in using masks so she used them to test the difference in the efficacy of the two different masks. The results, she said showed that the surgical masks were not efficacious. The N95 masks were, even when not fit tested. Pretty straightforward research on mask efficacy, and important because there is not much real data on this topic though there are many opinions.

As one panelist has pointed out, Congress has mandated that employers must protect their employees as much as possible with the best possible protection. Dr. McIntyre has proved that the N95 was the better mask via the Bejing study. Employers should provide the safer mask. At any rate, everyone reading this thread can listen to the presentations, and draw their own conclusions. The choice of what masks we will be wearing this fall may be out of our hands, as we are not the decision makers. We are just the worker bees.

We listen to the same data, but draw differing conclusions. Not surprisingly, panelists at the IOM meeting seemed to have the same problem. Some of us are just never going to agree. It may be part of being human.

[Woodenpug, BSN]

Or simply, that we have different concerns. I would see a lessening in the impact of pandemic flu. We can do that by practicing universal precautions, cough etiquette and knowing how to use the equipment at hand. Additionally, we can set the example and teach others. On the other hand, we can worry about improbabilities, decide that we are victims of "the man" and set our sites on cya. I prefer to not be a helpless victim.

[Laidback Al]

. . . in western culture non-compliance and lack of education are the greatest cause of influenza spread.

So, beside identifying this general problem (and I assume you mean for the entire population not just HCWs) what is your proposed solution to increasing compliance and educating people?

[Woodenpug, BSN]

So, beside identifying this general problem (and I assume you mean for the entire population not just HCWs) what is your proposed solution to increasing compliance and educating people?

It is the problem. It is also one we can address. My plan is simple. Teach, lead by example and gently reinforce compliance with your co-workers. You were only kidding right? You do know how to increase compliance, even without my input.

[Laidback Al]

It is the problem. It is also one we can address. My plan is simple. Teach, lead by example and gently reinforce compliance with your co-workers. You were only kidding right? You do know how to increase compliance, even without my input.

The only compliance I can increase is my own. I have little control over compliance of the people I interact with on a daily basis even though their behaviors could make me sick.

To be clear, I am not a HCW. As I understand some of these discussions, the compliance among HCWs is less than what it ought to be. If people (HCWs) that are on the front lines battling infectious diseases everyday have a low compliance rate, how we can expect the general population to act appropriately and take simple precautions to limit the spread of infectious diseases?

[Woodenpug, BSN]

Good point. Compliance is usually only a matter of a lack of knowledge. Other factors play a part and are studied ad nauseum. Check out the ODSF if you are interested in a fairly comprehensive, yet understandable model.

Part of what is need is a focus on the basics. Over attention to matters that are not in our control especially when those are of little real significance can also hurt compliance. The attitude is "Why bother it's not good enough to just adhere to hand hygene or cough/sneeze ettiquette." However, those very simple things are most effective and without them, M95's are just expensive, uncomfortable and hot.