Employee Health After the COVID-19 Pandemic: Stronger Than Yesterday
For providers on the front lines, lessons learned can help inform strategies to enhance the protection of their health going forward.
Infection prevention was first established in the 1970s by focusing on the health and safety of employees. Some examples of this include appropriate immunization coverage for employees, hand hygiene protocols, and blood and fluid exposure prevention measures.1 These programs have since evolved to include not just employees but also patients through prevention of health care–associated infections. Infection prevention programs should work in conjunction with employee health efforts regarding health care personnel blood exposure and infection clusters. The proper use of personal protective equipment (PPE) not only protects health care personnel from potential exposure, but also protects the patient from transmission of pathogens from the employee. The COVID-19 pandemic has permanently changed how we view employee health and safety. Employee stress and burnout of health care personnel became a hot topic, and there was increased focus on the physical and mental well-being of health care personnel.2 The pandemic expanded the role of occupational health services within an institution from traditionally being focused on managing workplace injuries and disease prevention to an extended focus on infection prevention. It also highlighted gaps and weaknesses in employee safety and the importance of having an organizational model that can respond quickly to future public health challenges and having policies and practices in place.3
VACCINATIONS
Immunization programs are occupational infection prevention and control services that help reduce the risk of transmission of vaccine-preventable diseases among health care personnel. Pathogen-specific prevention strategies ensure health care personnel have received the recommended immunizations and have evidence of immunity to vaccine-preventable diseases. The goal is to prevent employee-to-employee transmission and employee-to-patient transmission, potentially reducing the need for reactive measures such as postexposure prophylaxis (PEP) and employee shortages due to absences.4 As of November 2021, the Centers for Medicare & Medicaid Services requires employee COVID-19 vaccination in order for a participating institution to be reimbursed, with vaccination exceptions limited to those recommended by the Centers for Disease Control and Prevention.5
Occupational health played a valuable role in mass vaccination campaigns of health care personnel, with occupational health nurses providing a critical role in mobilizing these campaigns. The quick rollout of the COVID-19 vaccine led to a lot of vaccine hesitancy, even among health care personnel. Many studies have evaluated the attitudes and beliefs surrounding the vaccine and vaccine acceptance in this population. A more holistic approach has been shown to be effective when educating employees, resulting in increased vaccine acceptance.6 Occupational health physicians are in a special position to champion vaccination and address vaccine hesitancy because they know the culture of the health system and may also know the employees.7
IMPACT OF EMERGING INFECTIOUS DISEASES ON EMPLOYEE HEALTH AND HOSPITALS
In addition to bringing about a quick response to vaccination campaigns, the COVID-19 pandemic emphasized the need to be able to respond quickly to emerging public health threats to maintain a safe work environment. Aside from keeping up with continuously changing regulations, institutions needed to quickly implement safety measures to protect their employees from contracting the virus, including providing adequate PPE. With the recent outbreak of monkeypox and the need to roll out another vaccination campaign, occupational health services were more prepared to distribute vaccines in an efficient manner. Similar to COVID-19 vaccines, monkeypox vaccines were initially limited, and therefore collaboration with infection prevention and occupational health on criteria for vaccination was important for a successful monkeypox vaccine program.8,9
During the pandemic, Massachusetts General Hospital developed a web-based mobile-responsive app to screen employees for COVID-19 symptoms. Upon identification of their first patient with monkeypox, their Monkeypox Response Team, which included infection prevention and occupational health services, was able to implement a similar screening tool. The tool was designed to rapidly identify possible monkeypox exposure, perform risk assessments and stratification, and monitor symptoms. In conjunction with the exposure risk assessment and stratification tool, standard contract tracing and exposure investigations were implemented. This allowed prompt identification of exposed health care personnel who may have needed PEP and follow-up. Overall, the hospital found that the integration of the data collection tool into clinical support postexposure protocols was a useful and innovative approach to optimize workflows in the response to the monkeypox outbreak.10
Because of focused efforts on decreasing antimicrobial resistance before the COVID-19 pandemic, the United States had succeeded in reducing deaths related to antimicrobial-resistant infections. Over the last few years, however, we have seen a significant increase (>15%) in hospital-acquired, drug-resistant infections. These difficult-to-treat infections can pose a risk to employee health and increase the need for PPE when taking care of patients with these resistant pathogens. Infection prevention campaigns that were derailed during the pandemic have since started targeting strategies such as hand hygiene to decrease risk of transmission of antimicrobial resistance and promote the safety of patients and employees.11
LOOKING FORWARD FROM COVID-19
To enhance overall health and well-being post pandemic, employee health and infection prevention must continue to grow and learn from the evolving needs. Some strategies for improving immunization coverage of health care personnel in particular include conducting education to promote awareness and knowledge about vaccines, providing free access to vaccinations, offering multiple locations and times for vaccine clinics, providing incentives to encourage vaccinations, and more. Education that includes a platform to discuss medical and nonmedical reasons to decline vaccination is imperative to be able to gather and review information on why recommended vaccines are not administered and assess quality improvement.4
Another strategy that occupational health services can implement is to provide PEP and implement work restriction or appropriate PPE guidance to prevent employee-to-employee transmission and employee-to-patient transmission. During both the COVID-19 pandemic and monkeypox outbreak, similar strategies were implemented and will be an important consideration in future health emergencies.11
State health departments and the Occupational Safety and Health Administration provide guidance on preventing the spread of infectious diseases, including guidance on employee screening, mask requirements, and social distancing. The preparedness of the government in the beginning of the COVID-19 pandemic was lacking, but has since improved with the monkeypox outbreak.12 As witnessed during the pandemic, guidance evolved quickly and required a multidisciplinary approach, including input from occupational health and infection prevention programs.13 Using what was learned during the pandemic and creating an emergency response plan is imperative to prevent the spread of future disease outbreaks. As Ebola cases have continued to rise in Uganda, lessons from the COVID-19 pandemic on emergency preparedness and response management are at the forefront of health care systems’ planning.14
References
1.Weber DJ, Sickbert-Bennett EE, DiBiase LM, et al. A new paradigm for infection prevention programs: an integrated approach. Infect Control Hosp Epidemiol. Published online July 14, 2022. doi:10.1017/ice.2022.94
2.Impact of the COVID-19 pandemic on the hospital and outpatient clinician workforce. Assistant Secretary for Planning and Evaluation Office of Health Policy. May 3, 2022. Accessed November 4, 2022. https://aspe.hhs.gov/sites/default/files/documents/9cc72124abd9ea25d58a22c7692dccb6/aspe-covid-workforce-report.pdf
3.Peters SE, Dennerlein JT, Wagner GR, Sorensen G. Work and worker health in the post-pandemic world: a public health perspective. Lancet Public Health. 2022;7(2):e188-e194. doi:10.1016/S2468-2667(21)00259-0
4.CDC. Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services. Updated October 25, 2019.Accessed October 30, 2022. https://www.cdc.gov/infectioncontrol/pdf/guidelines/infection-control-HCP-H.pdf
5.Medicare and Medicaid programs; omnibus COVID-19 health care staff vaccination. Federal Register. November 5, 2021. Accessed November 4, 2022. https://www.federalregister.gov/documents/2021/11/05/2021-23831/medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-vaccination
6.Ciardi F, Menon V, Jensen JL, et al. Knowledge, attitudes and perceptions of COVID-19 vaccination among healthcare workers of an inner-city hospital in New York. Vaccines (Basel). 2021;9(5):516. doi:10.3390/vaccines9050516
7.Riva MA, Paladino ME, Paleari A, Belingheri M. Workplace COVID-19 vaccination, challenges and opportunities. Occup Med (Lond). 2022;72(4):235-237. doi:10.1093/occmed/kqab080
8.Wortman ZE, Kansagra SM, Tilson EC, Moore Z, Farrington DC, Kinsley KH. To drive equity in monkeypox response, states should learn from COVID-19. Health Aff Forefr. doi:10.1377/forefront.20220923.180528
9.CDC. Infection prevention and control of monkeypox in healthcare settings. Updated October 31, 2022. Accessed November 4, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html
10.Zhang H, Dimitrov D, Simpson L, et al. A web-based, mobile-responsive application to screen health care workers for COVID-19 symptoms: rapid design, deployment, and usage. JMIR Form Res. 2020;4(10):e19533. doi:10.2196/19533
11.CDC. Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2021). Accessed October 30, 2022. https://www.cdc.gov/infectioncontrol/pdf/guidelines/infection-control-HCP-H.pdf
12.Nuzzo JB, Bell JA, Cameron EE. Suboptimal US response to COVID-19 despite robust capabilities and resources. JAMA. 2020;324(14):1391-1392. doi:10.1001/jama.2020.17395
13.Protecting workers: guidance on mitigating and preventing the spread of COVID-19 in the workplace. Occupational Safety and Health Administration. January 29, 2021. Updated August 13, 2021. Accessed November 4, 2022. https://www.osha.gov/coronavirus/safework
14.Top 10 Ebola response planning tips: Ebola readiness self-assessment for state and local public health officials. CDC. Updated August 6, 2019. Accessed November 4, 2022. https://www.cdc.gov/vhf/ebola/outbreaks/preparedness/planning-tips-top10.html
