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Unmasking the evidence

Coughs_and_Sneezes_Spread_Diseases_Art.IWMPST14133Many DHBs have been talking about forcing staff who don’t get the flu vaccination to wear masks.

It’s one of those things that on first glance might seem like a good idea, but peel back a few layers and you’re left with the bitter taste of a purely punitive measure.

NZNO acknowledges the right of every person to vaccinate or not. We encourage it, of course; to the extent that we pay for our own staff to get the flu vaccination if they choose to. Healthy workplaces are a priority. We believe education and access are key to improving uptake but we do not think mandatory vaccination is the way forward.

DHBs want safe environments for their staff and patients too and we applaud that. What we’re saying is the DHBs are grabbing onto a “solution” that’s not evidence-based and seems to be designed to shame individuals rather than keep staff and patients safe from the flu.

We do not support the use of face masks to protect patients from unimmunised nurses.

For one thing, masks don’t work. Evidence shows masks are ineffective in protecting healthcare workers from patients with flu; so why do DHBs think the opposite would be different?

For another – a nurse with the flu would only be able to pass it on to a patient or colleague if he or she was at work. Nurses should not be working, or be made to feel that they should have to be at work, when they are sick. DHBs need to make sure enough staff are available to cover the inevitable rise in sick leave during “flu season”.

And it’s not just nurses. There must be clear information for patients, staff, contractors and visitors that sick people should stay away.

DHBs should also be promoting good hand washing and the use of tissues for coughs and sneezes.

Our motto is “Freed to care, proud to nurse” and we want that for every single NZNO member. Please don’t hesitate to give us a call if you are being treated unfairly 0800 28 38 48.

Here is NZNO principal researcher, Dr Léonie Walker’s analysis of the evidence for and against masks to protect against flu.

Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%1.

The efficacy of any respiratory device depends on user compliance. Workers’ tolerance for wearing most types of respiratory protective devices is poor and often declines over the course of a work shift; in one study, no more than 30% of workers tolerated these devices consistently throughout an 8-hour workday, citing difficulties with speaking and communication, discomfort, and other physical problems2.

The Institute of Medicine committee has recommended that current Centers for Disease Control and Prevention guidelines for respiratory protection be maintained3. Until more data are available, the Institute of Medicine committee recommended the use of personally fitted, N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces4.

1Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control (2008);36:276-282

2Radonovich LJ Jr, Cheng J, Shenal BV,Hodgson M, Bender BS. (2009) Respirator tolerance in health care workers. JAMA ;301:36-38

3www.cdc.gov/h1n1flu/guidelines_infection_control.htm.

4Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D (2009) Novel H1N1 Influenza and Respiratory Protection for Health Care Workers N Engl J Med 361:1823-1825”

 


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An ordeal with the flu

Kate and Sam Pohe

Sam Pohe (on the right) with her sister, Kate.

Community clinic nurse Sam Pohe’s job was to endorse the flu vaccine to her high-risk patients but, as she lay in a coma at death’s door, her body riddled with complications deriving from influenza, it became obvious she’d forgotten to get one herself. She shares her ordeal with Jodi Fraser.

The Whangarei 45-year-old was usually one to practise what she preached but, last year, got so busy vaccinating her patients, she forgot to get immunised herself.

Sam recalls leaving work early one day in August, thinking she had a cold.

“I was just feeling rather poorly. I left work early and went home to bed. I think I slept for three days. On the third day I woke for some reason, went to the bathroom, as I knew something wasn’t right, and I was blue.

“I text my friend to say ‘Why am I a blue colour?’ I called the ambulance and was taken to hospital ED. My oxygen sats (oxygen-saturated) were about 70 per cent and dropping.”

She was admitted to ICU soon after and placed on a bipap machine to help her breathe.

“I was struggling to breathe for six or seven days – it was terrifying. I never want to experience that again.”

A day later Sam’s doctor told her ‘We have to talk’.

“I remember looking at him and saying: ‘This is it? I’m going to die? … I need to make a few calls.’

That was Sam’s last lucid memory for the next three and a half weeks as she sank into a coma with multi organ failure.

While her beloved dogs pined for their mistress at home, her family and friends rallied round her bedside where she had been flown to Auckland, with her best friend flying over from Australia.

Sister Kate says she was shocked when she saw the state of her close sibling.

“There were tubes and wires everywhere. Just seeing Sam like that – it was awful. It was the worst experience of my life but Sam is stubborn and strong-minded and I never had any doubt that we would lose her.

“We had a family meeting and, despite being told we shouldn’t get our hopes up, looked into all the options.

“A lot of research doctors came in and I just signed her up for everything.”

While doctors considered placing Sam on the ECMO (heart and lung) machine, Kate spent the long tough days giving her sister foot and head massages, singing and reading to her.

“We all handled it differently – our nephew, who is usually really tough, just sat in the corner sobbing his little heart out. I’d wake in the middle of the night and hear dad crying which would set me off.”

While her family fretted and grieved, Sam was off in India having crazy exploits which still give her nightmares today.

“I remember having many vivid dreams while in the coma. I think I was in India with random people and we were at this place praying for forgiveness. I was paying penance I think, but I’m not sure what for. Another time I was in a bus and the oxygen was running out – I kept reaching for the handle to get out but I couldn’t move my arms. It was horrific. Other things happened but I won’t talk about them – they are too freaky.

“After I came out of the coma, a spiritual friend of mine asked me who Renee was. That is my aunt who’s passed so I believe I met with her.”

As Sam came out of her coma she remembers everyone peering down at her.

“I don’t remember what my thoughts were but my nephew told me the first thing I said was **** off to the nurses. I was shocked. I was terrified, frustrated, hallucinating. I could not walk or talk. I had a tracheostomy in situ. I was literally a dead weight. I couldn’t even lift my arms they felt so heavy. My hair was a mess, I hated being turned and my bottom wiped, I was on dialysis, I had double pneumonia, H1N1, influenza A – you name it, I had it all. I was one sick puppy.

“My emotions were all over the place and I heard I was a bit of a struggle for the nurses but I felt hopeless, useless and trapped against my own will. I just wanted to get out of bed and walk home. I said to my brother, ‘Just back the car up and I’ll pull all these lines out’ and I was trying to do just that.”

Despite the odds, Sam made a miraculous recovery and, cited a ‘medical mystery’, was finally told she could go home seven weeks later.

“I would have run if I could. “My dogs were so happy to see me, they were doing somersaults.”

Since then, she has pushed her limits every day, despite a damaged lung capacity which causes shortness of breath – the only long-lasting physical effect.

After four month’s rehabilitation, Sam has returned to work, albeit in a different less stressful job and says she absolutely advises her patients to get the flu vaccine.

“Sometimes they say to me, ‘But it’s just a little chest infection’ and I say, ‘Yeah? I had a little chest infection and it nearly killed me’.”

And there is no way Sam will get too busy to have the vaccine herself.

“Life is different now. I live like never before. I don’t feel as stressed anymore and I’m happy to be alive.”

Nine months later Sam still gets emotional while recalling her experience.

“When I was in hospital and I’d see the helicopter come in, I’d just cry because they are awesome, just awesome,” she says, tearing up. “I’m into raising money for the helicopter now – they are so good.”

A pioneer in setting up rural health clinics for vaccination, Sam is a strong advocate for making sure that health services are accessible for Northlanders.

“We used to find out which children hadn’t been vaccinated and go out and search for them.  It would be like, down this dirt road, hang a right, down a gully to find the brown house.

“I knew the people from a whanau perspective and they trusted me. Very often they didn’t have a car so they welcomed us to go to them and vaccinate their children. I will never forget sitting in a paddock with sea views, surrounded by babies playing in the dirt, while we watched them for 20 minutes after they had had their vaccinations.”

Her advice to others, having come so close to death?

“Make sure you get your flu vaccination because life is for living – oh and don’t sweat the small stuff.”