Risk factors

Rheumatologists uncertain about advising immunocompromised health care workers


Rheumatologists are uncomfortable providing recommendations regarding the workplace risk of infection for their patients who are immunocompromised health care workers (HCW), Australian research shows.

In a survey of 52 rheumatologists and trainees from Victoria and Tasmania conducted in August 2020, most (79%) had provided care to at least one immunocompromised HCW.

Of those patients, 40% had asked for advice about their risk of infection in the workplace.

The study, published in Infection, Disease & Health, showed that rheumatologists reported they were most confident providing information about influenza and hepatitis but less confident in providing information about tuberculosis, shingles and COVID-19.

They said they sourced their information mostly from colleagues (76%), government or society websites (64%), or journal articles (62%).

The authors, including Associate Professor Anne Powell said it was the first study to report rheumatologists’ attitudes towards providing targeted advice to immunocompromised HCWs.

“Most rheumatologists believe employers should be involved in advising immunocompromised HCW on minimising workplace infection risks,” they said.

“However, hospital infection prevention and staff clinics do not universally provide individualised advice, and often refer immunocompromised HCW back to their treating specialist.”

“The findings of this study therefore highlight uncertainty in managing immunocompromised HCW in a clinically significant proportion of these rheumatologists.”

Expectations

They said there was a need for more formal guidance for rheumatologists in advising immunocompromised HCWs.

“Given the number of other specialty groups that also manage immunosuppressed HCWs, a coordinated approach to develop a comprehensive and up to date resource is warranted. It appears there is an expectation that both rheumatologists and workplaces should play a role in advising their immunocompromised employees about how to mitigate workplace risk.”

Associate Professor Powell, from the rheumatology department at the Alfred Hospital, told the limbic that COVID-19 had highlighted a pre-existing issue regarding healthcare worker safety.

She said rheumatologists were being asked by immunocompromised patients who were healthcare workers about which environments that they could work in or did they need to change their job descriptions.

“So these sort of questions raised for us … well, how careful are we? Because the health services are saying go talk to a specialist, but then the specialists are often not within the healthcare system or that hospital and are not sure of the exact requirements in that hospital and how it operates.”

She said a lot of hospitals don’t even have staff clinics.

“So there wasn’t even the option for people to be assessed within the health system. And we also know that different hospitals have different infrastructures… different levels of negatively ventilated rooms and separation of infectious diseases from other patients,” she said.

“There were a lot of healthcare workers that were told not to work in intensive care, for example, but that’s their life career. And so you are making decisions for people without really understanding the environment and the impact on them as individuals. Not a lot of work has gone into what’s safe and effective for our patients in terms of where they can work and what they can do.”

“So I think the next stage that we’re working on is trying to develop a framework on how to make those connections between the workplace and the specialist and to gather information so that we can best advise people collaboratively on their safety and what mechanisms need to be put in place.”

She said the ongoing work was being done in collaboration with infectious diseases specialist Professor Allen Cheng.

“I think it’s probably a very good collaboration between rheumatology units and the infectious diseases and public health units to try and create something from there.”

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