UBC MEDICINE
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L – R: Annalee Yassi and Elizabeth Bryce. Photo credit: Martin Dee (above) and chuck russell (facing page)
Making hospitals healthier places Tuberculosis, once thought to be vanquished, has made an alarming comeback – in 2010, 8.8 million people got the disease and 1.4 million died from it, almost all of them in the developing world. But the risk faced by health care workers has been largely overlooked, even though they face the highest risk of contracting it, and can then spread it to others. Annalee Yassi and Elizabeth Bryce know well the perils of neglecting the health of health workers. During the SARS epidemic of 2003, health workers represented almost half of the cases. “People think health workers can get by with ‘corridor consultation’ – if they have concerns, they can just talk to their colleagues,” says Dr. Yassi, a Professor in the School of Population and Public Health who specializes in occupational medicine. “Ironically, there is less focus on the well-being of health care workers than there is for most other sectors.” Dr. Yassi and Dr. Bryce, a Clinical Professor in the Department of Pathology and Laboratory Medicine who heads infection control for Vancouver Coastal Health, joined forces as a result of that crisis. After the outbreak subsided, they determined what protective measures should be used by health workers, depending on the patient’s symptoms, the procedure being done and the setting. Then they adapted their evidence-based recommendations into easy-to-follow guidelines, checklists, diagrams, online tutorials and face-to-face training sessions. “SARS brought us together, and we found that we really enjoyed working together,” Dr. Yassi says. “That was the silver lining to this.” They have since taken that approach to places where infection control is even more pressing – the developing world – and applying it to diseases, like TB, that are similarly contagious, but far more persistent. Building on work originally done for B.C.’s health care workforce, Drs. Bryce and Yassi created the Occupational Health and Safety
Information System (OHASIS), a web-based system to track incidents, exposures, risks, immunizations and infection among health workers in health facilities or even entire health systems. They also developed a workplace audit that enables health workers to systematically evaluate their facilities and identify problems, and a new online tutorial, “Protect Patti” (http://innovation.ghrp.ubc.ca/ProtectPatti/eng/) to train health workers about personal protection. The outbreak of H1N1 in 2009 spurred the Pan-American Health Organization to take up these tools. (Drs. Bryce and Yassi had previously helped Ecuador lower its rate of hospital-acquired infections.) In South Africa, however, TB is the over-arching threat – one that is unlikely to recede any time soon. Their tools are being piloted in two hospitals in the Free State province of South Africa. Although Drs. Yassi, Bryce and Jerry Spiegel (a Professor in the School of Population and Public Health) are conducting a study of the programs’ efficacy there, South Africa’s national laboratory service has already adopted it. Such rapid roll-outs make Dr. Yassi a bit uneasy, given hospitals’ sorry track record of implementing and maintaining information system tools. “They rarely get used properly, because the technology is transferred without understanding the constraints of where it’s being used,” she says. But she understands the urgency, especially in a country where most of the population has latent TB (the bacteria is in their lungs, but hasn’t spread and isn’t yet causing symptoms), and especially among a workforce that is five to seven times more likely than the general population to be admitted to the hospital for the drug-resistant variety of the disease. “We need to make infection control a workplace issue,” Dr. Bryce says. “Protecting heath care workers is synonymous with protecting patients.”