October 7, 2009
AHS Releases Pandemic (H1N1) 2009 Response Plan
Over the summer months and into the fall Alberta Health Services has been working on developing a response plan to deal with the current H1N1 pandemic. The completed plan was provided to UNA on October 2, 2009. The document (pdf ) provides a general over view of AHS's response plan covering a variety of areas such as response coordination, public health measures, ethics communication and infection control.
More specific clinic care plans for bed management and staff resource requirements are still being developed for each site.
In addition to developing the response plan AHS has been meeting with representatives of UNA, AUPE and HSAA on a weekly basis to provide updates to the unions on the various aspects of the response plan and to discuss concerns brought forward by staff to their unions. Representatives of AHS are also planning to meet with each union to discuss potential impacts related to their collective agreements. Any concerns regarding fit-testing and/or supply of N95 respirators should be forwarded to your Local UNA representative or Labour Relations Officer
If all this seems like too little too late - we agree. UNA along with the other nursing unions have been lobbying the federal and provincial governments to put appropriate plans and protections in place. The move to one big health authority has just added to the delay and confusion and the recent freeze on hiring has left our members wondering if there will be enough nurses to care for the estimated 3,800 to 11,400 patients who will require hospitalization.
New! AHS Point of Care Risk Assessment
On October 2, 2009 AHS released a new directive entitled “Point of Care Risk Assessment” ( pdf ). The purpose of the directive is to provide clarification regarding the use of N95 respirators.
In this directive AHS has changed their guidance regarding the use of N95 respirators to be in line with the “Best Practice Guideline for Workplace Health and Safety During Pandemic Influenza” recently issued by the Government of Alberta.
“A fit-tested N95 respirator is required for any encounter with a patient who has, or is suspected of having, influenza-like illness (ILI) in the following situations;
1. Any HCW encounter occurring within 2 meters of a forcefully coughing/sneezing patient who is unable/unwilling to comply with respiratory etiquette;
2. Any patient undergoing an Aerosol Generating Medical Procedure (AGMP)”
This best practice guideline was developed without input from health care unions or front line health care workers. UNA has written to the Minister of Labour to express our concerns that the guidelines do not provide adequate protection for health care workers in the event of a pandemic.
Another requirement included in the new directive is that Health Care Workers will perform a Point of Care Risk Assessment as outlined by the Public Health Agency of Canada (PHAC) (pdf) to determine the need for N95 respirators. It is the expectation of the employer that nurses will use their professional judgement in determining if the level of risk of exposure and utilize the appropriate infection control procedures and don appropriate personal protective equipment.
Ultimately it will be the nurse's responsibility based on their professional assessment of the situation to determine what level of respiratory protection is required.
It is the position of United Nurses of Alberta that until such time as there is scientific certainty regarding the mode of transmission of H1N1 influenza all nurses that are required to provide care for patients suspected or confirmed to have H1N1 influenza must be provided with an appropriate supply of fit-tested N95 respirators and mandatory education regarding the care of procedures for donning and doffing N95 respirator. Along with donning N95 respirator you should also be wearing gloves, gown and eye protection.
We urge our members to get fit-test as soon as possible and to err on the side of caution and insist on wearing a N95 respirator when you come into contact (within 2 meters) of a patient suspected or confirmed to have H1N1 influenza.
Questions about Immunization
Many nurses have forward concerns regarding HINI immunization. This is not a new concern and one that UNA has dealt with previously related to seasonal flu immunization.
During a number of past outbreaks of seasonal influenza some health care employers with the support of the Medical Officer of Health have issued policies that directed employees who had not been immunized or taken anti-viral prophylaxis 14 days prior to the declared outbreak not report to work. If the nurse could not be immunized based on medical reasons she/he would be paid sick leave during the period they could not work. However, if the nurse chose not to be immunized for other reasons then she/he would not receive sick leave and would have to use other forms of paid leave credits to cover any loss of wages.
One of these policies was issued at the Lethbridge Regional Health Centre and a grievance was filed on behalf of UNA Local 120 alleging that the policy was inconsistent with the provisions of article 19.01(a)of the collective agreement. This grievance was advanced to arbitration and in a 2002 decision Arbitrator Jolliffe found that the policy was not inconsistent with article 19.01. Similar employer policies have been grieved and arbitrated by health care unions in other provinces and all of these grievances were denied. To date AHS has not issued any policies related to H1N1 staff immunization.
Am I required to take the seasonal flu vaccine or the H1N1 vaccine when it is offered?
Under the Human Rights Act you have the right to refuse any vaccine or anti-viral prophylaxis offered. However, your employer could issue a policy that directs employees who had not been immunized or taken anti-viral prophylaxis 14 days prior to the declared outbreak not report to work. If the nurse could not be immunized based on medical reasons she/he would be paid sick leave during the period they could not work. However, if the nurse chose not to be immunized for other reasons then she/he would not receive sick leave and would have to use other forms of paid leave credits to cover any loss of wages.
If I refuse to take the vaccine or miss being vaccinated because I am absent from work can I be disciplined?
No - You cannot be disciplined for refusing to be vaccinated or to take anti-viral prophylaxis.
What if I refuse to be vaccinated and/or refuse to take Tamiflu and I get sick?
As long as you are eligible for sick leave credits if you are become ill with seasonal or H1N1 influenza you will be paid sick leave during the period you are off work regardless. If you are sick then you should be paid sick leave as per the collective agreement.
What about Workers Compensation?
Any nurse who comes into contact (two meters) with a patient with confirmed H1N1 influenza and they are not wearing the appropriate personal protective equipment should notify their immediate supervisor and call the OHS&W Blood and Body Fluid report line to report their exposure. If the nurse subsequently becomes symptomatic they should file a WCB Workers Report of Incident form. It is our understanding the WCB will be asking employer's Occupation Medicine Physicians and/or Public Health Officers to certify that the employee was in contact with a confirmed case of H1N1. Based on that medical information they will be accepting claims for compensation.
What You Need to Know:
Get Fit Tested! - The Multi-Employer/UNA Joint Committee has reached an agreement regarding N95 Respirator Provision and Fit Testing, which requires the employer to provide N95 respirator fit-testing to all employees covered by the Multi-Employer/UNA Collective Agreement. Fit-Testing is mandatory as per Article 35.02 (a)
Ensure you have enough N95 respirators - The Joint Committee agreement obligates the Employer to ensure that an appropriate supply of N95 respirators is available.
You may be temporarily transferred - In the event of an emergency Article 44: Mobility (44.05 (e)) allows the Employer to reassign Employees from any site to perform work at any other site in emergency circumstances. An emergency is defined as “an unforeseen combination of circumstances or the resulting state that calls for immediate action”. Contact you Local representative or Labour Relations Office for additional information regarding emergency transfers.
Do not report to work if you are sick - Nurses should not be reporting to work if they have influenza like illness (fever and respiratory symptoms). Nurses who do report to work are putting patients and their co-workers at risk of infection and illness. The Alberta Government is asking that individuals with flu like symptoms stay home from work and avoid public places when ill.
You do not have to put your health at risk - The agreement between the parties states that employees who have not been fit-tested for an N95 respirator or are unable to achieve an effective facial seal shall not be expected to enter or provide services in an area where a suspected or confirmed case of swine influenza A has been identified. These Employees may be deployed to another area.
You need to assess whether you believe that you need to provided with N95 respirators (fit-tested), gown and eye protection. If your employer refuses then ask to be reassigned.
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