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HCWs' travel to Mexico complicates response
Furlough, screening measures considered
Though Chicago is roughly 1,700 miles from Mexico City — the epicenter of the H1N1 influenza A outbreak — it didn't take long for the virus to get there when warnings of a possible pandemic began coming out.
"The first two probable cases that we had were among health care workers," says Steve Weber, MD, health care epidemiologist at the University of Chicago. "We had one individual who was a returning traveler from the endemic area and we believe that was the principal point of contact."
That worker then apparently infected an office mate, though fortunately neither were involved in direct patient care duties. Both workers stayed out of work until their symptoms resolved, but it was a rude introduction to a rapidly evolving situation.
"That was just as the awareness was growing both in Mexico City and here," he says. "We did contact tracing for both of those individuals. Because their job roles didn't have any direct patient care responsibilities we were able to identify other hospitals employees with whom they had had contact with in meetings and what not, which was a relatively modest number."
With that incident as a jump-start, the hospital set up screening areas for both patients and workers to identify any suspect cases.
"We extended that screening as well to students and staff at the university because of their unique epidemiological circumstances — going back to dorms," Weber says. "If anyone was having any symptoms we asked them to go to the screening center. The first couple of days of the epidemic people were being tested with rapid testing for influenza A with positive results going on to the state lab and ultimately CDC if it came to that."
At the last count, four people were confirmed positive, two patients and the aforementioned two employees.
Issues with employees immediately surfaced as well for Sue Sebazco, RN, an infection preventionist and employee health professional at Arlington (TX) Memorial Hospital. "Living so close to Mexico, we have employees who go to Mexico frequently to visit family," she says. "So, we're getting questions [from managers about] staff going to Mexico and what should we do with them? I said, 'Tell them not to go right now until we know more about what's going on unless it's a dire emergency.'"
Asymptomatic workers who returned from Mexico — either for family visits or vacation — were immediately put on symptom screening, she says. "We did not furlough them, but just checked them daily," she says. "We let them work and check in with us everyday." (See screening form.)
Beyond that, she regularly met with all workers to assess their perceptions of the burgeoning pandemic and see what information they needed. "We asked our employees in meetings, 'What are we not doing that we need to do? What are we not helping you with?'"
The primary concern among employees was becoming infected and exposing their families to the virus. Nevertheless — though some surveys have projected otherwise — employees kept reporting for work even when some local schools closed, she says. "I was impressed that the reaction of our workers overall was very calm," Sebazco adds.