Preventing the next 'SARS' - European healthcare workers' attitudes towards monitoring their health for the surveillance of newly emerging infections: qualitative study

Abstract

BackgroundHospitals are often the epicentres of newly circulating infections. Healthcare workers (HCWs) are at high risk of acquiring infectious diseases and may be among the first to contract emerging infections. This study aims to explore European HCWs' perceptions and attitudes towards monitoring their absence and symptom reports for surveillance of newly circulating infections.MethodsA qualitative study with thematic analysis was conducted using focus group methodology. Forty-nine hospital-based HCWs from 12 hospitals were recruited to six focus groups; two each in England and Hungary and one each in Germany and Greece.ResultsHCWs perceived risk factors for occupationally acquired infectious diseases to be 1.) exposure to patients with undiagnosed infections 2.) break-down in infection control procedures 3.) immuno-naïvety and 4.) symptomatic colleagues. They were concerned that a lack of monitoring and guidelines for infectious HCWs posed a risk to staff and patients and felt employers failed to take a positive interest in their health. Staffing demands and loss of income were noted as pressures to attend work when unwell. In the UK, Hungary and Greece participants felt monitoring staff absence and the routine disclosure of symptoms could be appropriate provided the effectiveness and efficiency of such a system were demonstrable. In Germany, legislation, privacy and confidentiality were identified as barriers.All HCWs highlighted the need for knowledge and structural improvements for timelier recognition of emerging infections. These included increased suspicion and awareness among staff and standardised, homogenous absence reporting systems.ConclusionsMonitoring absence and infectious disease symptom reports among HCWs may be a feasible means of surveillance for emerging infections in some settings. A pre-requisite will be tackling the drivers for symptomatic HCWs to attend work.

What could clinicians do to prevent hospital-based outbreaks of emerging and existing respiratory infectious diseases? Raising awareness is key

“…Staffing demands and loss of income were noted as pressures for healthcare workers to attend work when unwell. However, issues related to legislation, privacy, and confidentiality were previously identified as barriers towards monitoring staff absence and the routine disclosure of symptoms [1] . In short, there are measured barriers to preventing disease spread.…”

“…Aghaizu and associates [1] also identified known measured barriers for the timely recognition of outbreaks of SARS-like infectious diseases within hospital settings. These barriers were (1) lack of knowledge among clinicians, (2) lack of employee absence-reporting mechanism, (3) differences in absence monitoring among hospital-affiliated workers and non-hospital-affiliated workers (e.g., self-employed doctors and agency nurses), (4) limited personal protective equipment and patient isolation facility due to financial restraints, and (5) lack of personnel and financial resources in hospitals' occupational health departments.…”

“…The qualitative study conducted in 2010 in 4 European countries by Aghaizu and associates [1] found that healthcare workers perceived risk factors for acquiring infectious diseases like SARS at work in hospital settings to be (1) exposure to patients with undiagnosed infections, (2) breakdown in infection control procedures, (3) lack of immunity, and (4) symptomatic colleagues. Aghaizu and associates [1] also identified known measured barriers for the timely recognition of outbreaks of SARS-like infectious diseases within hospital settings.…”

“…Aiming to prevent the spread of the next SARS-like emerging infectious disease, Aghaizu and associates [1] emphasized that "hospitals are often the epicentres of newly circulating infections. Healthcare workers…are at high risk of acquiring infectious diseases and may be among the first to contract emerging infections…".…”

“…Healthcare workers emphasized a desire for timelier recognition of outbreaks of emerging infections and for structural improvements of their working hospitals (e.g., standardized employee absence and infectious disease symptom reporting systems) [1] . They were concerned that a lack of monitoring and guidelines for infectious healthcare workers posed a great risk to colleagues and patients.…”