Health Care Workers and Swine Flu

To the Editor: In a recent article in the journal, Santos et al concluded that “physicians and medical personnel had a higher [swine flu] infection rate than other employee positions, whereas ED personnel had the highest infection rate.”1 This finding is interesting. There is no doubt that physicians and medical personnel can have higher influenza infection rates than other staff members. However, it is still questionable whether this high rate actually means that they are more likely to become infected. Respiratory pathogens can spread anywhere in a hospital, and everyone in it has a high probability of contact with them. An important concern is infectious control practice. If physicians and medical personnel, who must touch patients, do not practice good infectious controls (eg, regular hand washing), then infection can occur easily. In exigent locations such as emergency departments (ED), staff may be less compliant with infectious control practice than staff in other departments and infection rates there may be higher. Meengs et al proposed that “poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints.”2 It must be noted, however, that this report examined only a small sample in a single institution, with limited variables studied. Some recent data revealed that hand hygiene compliance in the ED can be as high as 90%, but that factors such as patients overflowing into hallways because of high volume, glove use, and other environmental factors may lower ED hand hygiene compliance.34 Thus, it is not certain that infection control practices may vary between health care worker types.