Pregnancy and H1N1

Take a moment to read an interesting story about one pregnant woman’s tragic experience with H1N1. In an ironic twist, the physical therapist helping this woman recover after her four month hospitalization also happens to be an anti-vaccine loony.

The danger this virus poses to pregnant women is impressive, and we’ve had some very frightening cases here as well. One of the many inconsistencies in public health guidance is the extent to which we go to provide a zero-risk environment for health care workers, while allowing pregnant day care workers and school teachers to continue working. Who do you think is at greater risk for H1N1 exposure?

Anyway, get them vaccinated.

What were they thinking?

A few months ago, CDC recommended that facilities consider reassigning pregnant healthcare workers to avoid caring for patients with confirmed or suspected swine flu. This week, SHEA, APIC and IDSA issued an opposing recommendation. These groups state that “automatic and uniform reassignment of high-risk healthcare personnel is neither necessary nor feasible.” The rationale is that reassignment of pregnant workers undermines confidence in the efficacy of personal protective equipment and infection control recommendations, and it creates privacy concerns for the reassigned workers. On this one, I must side with CDC, and am quite surprised that SHEA and APIC would issue such advice.

For many years, pregnancy has been known to be a major risk factor for morbidity and mortality in influenza. A recent paper analyzing the swine flu epidemic in the US showed that pregnant women were 4-5 times more likely to require hospitalization than others when infected with swine flu, and 13% of all deaths in the US from swine flu occurred in pregnant women. In my experience, pregnant healthcare workers often have anxiety related to acquiring infections in the workplace, and it seems reasonable to provide reassignment. Personal protective equipment is effective in reducing transmission but who hasn’t inadvertently been noncompliant with PPE because of an emergent situation or distraction, simply forgotten to don the appropriate gear, or touched an itchy eye or nose before hand hygiene? Moreover, the reality is that healthcare workers want minimal risk at work, even though they may be much less risk averse in their personal lives. In the end, effective infection control is a team sport and is built on trusting relationships between infection control personnel and frontline providers. Preventing infection is all about what happens in the messy, shades of gray world at the bedside, not in the black and white environment of the tidy conference room. If hospitals adopt policies that are interpreted as overly harsh and unsympathetic to the needs of their workforce, infection control in general will be undermined. SHEA and APIC need to apply a little common sense.