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Impact of expanded influenza post-exposure prophylaxis on healthcare worker absenteeism at a tertiary care center during the 2017–2018 season
Mireia Puig-Asensio MD, PhD, Margaret Douglas RRT, MPH, Stephanie Holley MBA, BSN, Mary E. Kukla BSN, RN, Oluchi Abosi MPH, MBChB, Lisa Mascardo PharmD, Brenda Carmody BS Pharm RPh, Courtney Gent PharmD, Daniel J. Diekema MD, MS, Patrick Hartley MB, BCh, BAO, Michael B. Edmond MD, MPH, MPA and
Jorge L. Salinas MD University of Iowa Hospitals & Clinics, Iowa City, Iowa
To the Editor—Healthcare workers (HCWs) are at risk of being exposed to influenza during routine patient care.1 Consequently, HCWvaccination is advised to reduce influenza-related morbidity and absenteeism.2,3 However, influenza vaccine effectiveness varies from season to season depending on the level of vaccine matching with circulating influenza strains. During 2017–2018, there was an expected predominance of
influenza H3N2, a subtype associated with lower vaccine effectiveness. We hypothesized that a surge in influenza cases paired with decreased vaccine effectiveness could increase HCWabsenteeismand impact the delivery of care. Historically, we offered oseltamivir postexposure prophylaxis (PEP) only to unvaccinated exposed HCWs, but during the 2017–2018 season, we expanded PEP to all exposed HCWs regardless of their vaccination status. We report our experience describing PEP uptake, cost, and impact on HCWabsenteeism at the University of Iowa Hospitals & Clinics (UIHC) during 2 influenza seasons (2016–2017 and 2017–2018). The UIHC is an 811-bed tertiary-care hospital that serves as a
referral and safety-net health system for eastern Iowa. During the 2016–2017 season, PEP (75 mg/day for 7 days) was offered free of charge to unvaccinated exposed HCWs. We defined exposure as proximity within 3 feet of a laboratory-confirmed influenza-infected person for ≥10 minutes without mask protection, or direct contact with respiratory secretions. Prophylaxis was not recommended if >48h had elapsed since the exposure. During the 2017–2018 season, PEP was expanded to all exposed HCWsregardlessof vaccination status. Other hospital infection control policies did not change over the study period: (1) Universal surgical mask use was advised for HCWs with direct patient contact in hematology-oncology units during respiratory virus season. (2) Oseltamivir prophylaxis was
Author for correspondence: Mireia Puig-Asensio, Division of Infectious Diseases,
Internal Medicine Department, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52246. E-mail:
mireia-puigasensio@uiowa.edu
Cite this article: Puig-Asensio M, et al. (2019). Impact of expanded influenza post-
exposure prophylaxis on healthcare worker absenteeism at a tertiary care center during the 2017–2018 season. Infection Control & Hospital Epidemiology 2019, 40, 260–261. doi: 10.1017/ice.2018.317
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
recommended to all patients and HCWs in units with nosocomial transmission of influenza (ie, ≥2 new cases of influenza in inpatients 72 hours ormore after admission). Influenza immunization status was recorded in a secure, on-line employee health portal (ReadySet, Axion Health,Westminster,CO).Influenza testingwas performedbypoly- merase chain reaction during both seasons. The study population was staff nursing and clinical technicians
who worked at UIHC in both adult and pediatric units (inpatient and outpatient). We reviewed surveillance, employee health, pharmacy, and human resources records for the 2016–2017 and 2017–2018 seasons.“Influenza season” was defined as October 1 throughMarch 31. For HCWs with multiple exposures, only exposure events that occurred>7 days apart were included. The primary out- come was the rate of absenteeism, expressed as all-cause sick leave in hours divided by the total scheduled work hours. We excluded absences<1 hour. We defined PEP uptake as prescriptions picked up divided by the number of HCWs who were referred. Oseltamivir prophylaxis prescribed because of nosocomial transmission was not considered PEP. Analyses were conducted in Stata version 15 software (StataCorp, College Station, TX). During the 2016–2017 and 2017–2018 seasons, we identified
373 and 427 laboratory-confirmed influenza cases, respectively. The proportion of HCWs who received the influenza vaccine was similar for both seasons (89.7% vs 90.8%). PEP was recommended for 15 exposed HCWs in 2016–2017 and 280 in 2017–2018, and 5 (33.3%) and 133 (47.5%) HCWs picked up oseltamivir from the pharmacy, respectively. Oseltamivir cost an average of $81.41 per PEP course. The total estimated cost of oseltamivir was $407 in 2016–2017 and $10,828 in 2017–2018. During the 2016–2017 season, there were 6,187 sick-leave requests with a median of 12 working hours (IQR, 10–24) lost per HCW. During the 2017–2018 season, there were 6,174 sick-leave requests with a median of 12 hours (IQR, 11.6–24). Absenteeism rates were similar in both influenza seasons (3.2% vs 3.4%, respectively). During the 2017–2018 influenza season, our recommendation
of providing PEP to all HCWs exposed to an influenza-infected case had no apparent impact on overall absenteeim rates or the
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