Jane Lipscomb
If you’re a direct care worker who may be exposed to people with swine flu, you should be fitted for a respirator and use it as needed to protect against becoming infected yourself. That’s what I told an IOM panel on August 20.
In a report that was published on September 3, the Institute of Medicine (IOM) recommended that health care workers use fit-tested respirators to reduce the risk of infection from swine flu.
Testifying before the IOM panel was another opportunity to explain why direct care workers should be included in the list of essential personnel who receive this protection article. This June, I made the same case in an article I coauthored for the American Journal of Public Health.
I told the panel that direct care workers may be at increased risk for the H1N1 flu for a number of reasons:
- They travel between/care for multiple frail elderly over the course of a day or week;
- They are more likely to need to work (no paid sick leave) when ill; and
- They are at increased risk of infection related to their income and lack of health insurance (30% have no health insurance coverage).
In the increasingly likely event of pandemic flu outbreak, direct care workers will be expected to care for their usual clients in the community, 30% of whom live alone, and one in five of whom have no other primary caregiver. They may also be asked to care for family, friends and other needy clients outside their caseload.
Unlike their colleagues who work in institutions, home care workers don’t usually have access to standard infection control measures. In a survey we conducted in Illinois in 2006, we found only 18% of home care workers reported having surgical masks available, none had access to N95/respirators, 57% said they were often told if a client has a contagious disease, and just over a quarter (27%) had gotten a flu shot in the previous year.
As an essential part of the health care infrastructure, I told the panel, direct care workers should direct receive high priority for
- Vaccination;
- Antiviral prophylaxis and treatment;
- Access to and training in use of respiratory protection; and
- Paid sick leave.
In addition, employers should make sure that N95 respirators are available to and fitted for their caregiving staff in accordance with OSHA regulations, and healthcare workers should use the equipment as required by regula¬tions and employer policies.
Jane Lipscomb, RN, PhD
Director, University of Maryland’s Work and Health Research Center
DCA board member
