Study investigates how healthcare workers caught H1N1

By: December 28th, 2010 Email This Post Print This Post

An investigation of confirmed cases of H1N1 among healthcare workers (HCW) during the 2009-2010 pandemic indicates that 50% were infected within a healthcare setting.

This is one of the findings of “Transmission of Pandemic (H1N1) 2009 Influenza to Healthcare Personnel in the United States,” an article by CDC researchers appearing in a special supplement on the H1N1 pandemic in the January Clinical Infectious Diseases.

CDC researchers worked closely with state and local health departments to examine the likely routes of H1N1 exposure in likely routes of exposure 70 HCWs covering 22 states.

Here are some highlights of the study:

  • More than half of the confirmed HCW H1N1 infections occurred in outpatient settings.
  • Of the HCWs infected by patients, only 20% used respiratory protection, such as N95 respirators or surgical masks, for all patient encounters.
  • Leading occupations for H1N1 infections were registered nurses (20%), physicians (19%), and nursing assistants (13%).
  • The study found more instances of  HCW-to-HCW transmission than expected.
  • Occupations where HCW-to-HCW transmission occurred were physicians (30%) and nurses (20%). HCW-to-HCW transmission also occurred with a nursing assistants, intake coordinator, medical assistant student, pharmacist, and patient relations staff member.

The study concluded that the likely patient-to-HCW and HCW-to-HCW transmissions in healthcare settings highlighted the need for comprehensive infection control policies which include administering influenza vaccine, appropriate managing ill HCWs, and adherence to infection control precautions such as respiratory protection PPE.

Click here for online access is to all the articles in The 2009 H1N1 Influenza Pandemic: Field and Epidemiological Investigations.


The study is informative but not one that I would want to base regulatory change on. We are talking about a disease that can be spread prior to the patient having symptoms. Given the public contact we all have, I think it is very difficult to categorize where someone was exposed.

In our Clinical facility, we investigated each case of a reported HCW with H1N1 and only found one that was probably due to exposure to a patient. In this case, the provider was exceptional at using PPE for any patient with any upper respiratory symptoms. He took care of one patient who had GI symptoms. The next day the patient returned with URI symptoms and had a positive Dx. for H1N1. All other of our cases had family members or other close contacts with diagnosed or symptomatic H1N1.

we had “comprehensive policies” and provided a lot of education. Unfortunately, OSHA can’t clone us 1:1 to make sure the HCW obeys them- but they still make us the scapegoat every time. I had nurses tell me in our peds ED that they didn’t plan to use masks because it “scares the children too much” OSHA-WE DO NOT NEED REGULATION AND ARE SICK & TIRED OF BEING THE SCAPEGOATS FOR LACK OF PPE USAGE!!!! It is an individual’s free will and choice that is wrong.

By David LaHoda on December 28th, 2010 at 9:45 am

Your free will exclamation may be your opinion, but it shows your serious misunderstanding of the law. OSHA standards clearly say that it is the employer’s responsibility to ensure proper PPE compliance for employees. Free will and choice is always tempered by workplace rules and regulations, and not just in matters of safety and health.

You go David! Too many people saying and making excuses “what about my rights to say no” or “my freedom” or “my choice”. When it comes to the health of your own loved ones or no matter who, just take responsibility and do the right thing! If it’s not for yourself, then do it for others, especially those you say you love and care about. Protect them! As a HCW, one day you may be the one bringing it home (asymptomatically) and if someone you know happens to be vulnerable to it, it may be too late then to be sorry. The laws are there to protect all. Our world is already so messed up now, don’t add to it.

I truly agree with the comments above. However I am one infection preventionist in a facility that employees over 1000 clinical staff. At the facility where I was employeed until this fall, there were 2 of us for a clinical staff of almost 3500 workers. And we had to do it all. If your administration is not a change advocate and does not encourage this in their managers, how can I do it? I do go to the noncompliant person’s manager as I have no power to make the employee do the right thing. The manager is also juggling many jobs and requirements. So, like me they can’t follow each and every employee. That is why I as saying- another mandate is not the answer unless the fines and reprecussons extend to the healthcare worker at fault. We also need the infection preventionist staffing issues addressed but neither the Joint Commission or the federal government looks at this. Nor do we get praised for our educaiton, good policies and procedrues- we get dinged when the HCW refuses to follow them and a surprise inspection is done and, oh my, we get cited for things we have asked be addressed all along. I was at the larger facility last year and our masks were available at the door to each room in our clinical areas- both inpatient & outpatient. We had posters at each entrance that asked people coming in with coughts, esp. with a fever to put on a mask until they were seen. There was extensive education done. One of us did rounds almost every day in the ED and our clinics during the H1N1 outbreak to address individual issues. I worked 0ver 70 hours/week for almost 3 months to get this plus my normal workload accomplished. Unfortunately, choice is an individaul matter and most of us are too understaffed to address it. So, until OSHA puts some of the burden on the healthcare worker and we get better staffing as the gatekeepers, it will not improve.

By David LaHoda on December 28th, 2010 at 5:24 pm

It sounds like you have difficult and overburdened work situation, and I am sorry you have to deal with that, but it is very unlikely that you will ever see OSHA pressuring or applying enforcement fines to workers. It’s just not in the cards.

The OSH Act of 1970 established regulatory oversight of the government for employers, not individual workers. It would take a major overhaul of the Act or new legislation to allow the government to directly cite workers. It’s just not in the cards. And in my opinion it shouldn’t be.

OSHA has consistently said that it is the employer’s responsibility to apply progressive disciplinary measures to non-compliant workers through internal policies.

In short, either your facility can exercise control/discipline over its workforce or it can’t.

If it can’t, or won’t, then, as harsh as it may sound, I wonder how competent the whole organization is in the first place.


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