1621a Learning from experience: identification of risks and control measures

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Abstract

The protection of healthcare workers (HCWs) from occupational infections developed in parallel with that of patients from healthcare-associated infections. In 1915, Richardson wrote that nurses avoided the care of patients with infectious diseases because they realised their insufficient training and feared the possible consequences. These obstacles could be removed by ‘a thorough training in fever nursing, which embraces a knowledge of the nature of infectious diseases, their modes of transmission and methods for their prevention.’ HCWs’ concerns did not change greatly over the following 100 years, nor did the validity of the proposed solution: but scientific and technical knowledge progressed. Several life-threatening pathogens were increasingly identified as causing epidemics involving HCWs and patients in the successive decades, including tuberculosis, ‘serum’ hepatitis and smallpox: recommendations and codes of practice for hospitals and laboratories were issued, but many institutions and HCWs were still not taking adequate precautions to reduce infection risks. HIV gave an unprecedented impulse to HCWs’ safety, promoting Universal Precautions against bloodborne infections, and airborne precautions against the HIV-associated resurgence of tuberculosis. With the decrease in the fear of occupational HIV, however, HCWs’ compliance with preventive measures dropped, and SARS hit. The risk of communicable disease lost its historical significance to acquire practical relevance, claiming many lives before an effective reaction ended the epidemic. SARS stimulated developments in alert systems, isolation precautions, design of barrier garments, training in donning and doffing, pre and post-exposure management. Nonetheless, Ebola found international organisations ill-prepared and frontline workers under-equipped and untrained, which sometimes advocated dramatic choices between the lives of patients and HCWs’ safety. If we want to learn from experience, HCWs’ safety standards must be global: promoting renewed understanding and prompt identification of risks and precautions, and concentrating efforts and resources to strengthen preparedness in areas where pathogens emerge, are our inextricable priorities.

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