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HSE document on pregnant and immunocompromised healthcare workers prompts concern

By Mindo - 23rd Mar 2020 | 18 views

Concerns have been expressed by doctors online about a HSE redeployment policy document (dated 19 March) which states that healthcare workers who are pregnant, immunocompromised or who have other conditions that put them at high risk of severe disease “do not need to be excluded from providing care” to patients with Covid-19, once infection prevention and control precautions are followed.

This policy conflicts with updated guidance for pregnant healthcare staff jointly issued on 21 March by a number of UK medical institutions including the Royal College of Obstetricians and Gynaecologists (RCOG).

According to RCOG guidance, healthcare workers who are more than 28 weeks pregnant or have underlying health conditions (at any stage of pregnancy) should avoid direct patient contact.

The full RCOG guidance is available at this link: https://www.rcog.org.uk/en/news/updated-advice-for-pregnant-healthcare-workers-and-employers-during-coronavirus-outbreak/

The HSE document says “healthcare workers who are pregnant, who are otherwise immunocompromised or who have other conditions that place them at high risk of severe disease but who adhere to recommended infection prevention and control precautions are unlikely to be at greater risk of acquiring Covid-19 infection compared with other healthcare workers and do not need to be excluded from providing care to such patients.”  

Such staff may be deployed in accordance with current occupational health advice, according to the document.

The cited HSE occupational health advice (outlined in a separate document, dated 19 March) says management have a responsibility to redeploy pregnant or immunocompromised staff from direct contact with a confirmed or suspected case of Covid-19, if the healthcare worker has requested this.

According to this occupational health document, the following healthcare workers “cannot be rostered” to work with patients with Covid-19:

  • those for whom it has not been possible to identify and provide appropriately fitting personal protective equipment [PPE]
  • those who are pregnant or immunocompromised secondary to illness or treatment, and who have indicated they would like to be redeployed.

A previous version of the HSE redeployment policy document (6 March) said employees most at risk of contracting Covid-19 in the workplace (eg, age 60 years or over, have a long term medical condition, immune suppressed, pregnant) “will be assigned to non-direct contact areas”.

A section of an email to some doctors, outlining the latest redeployment policy, was posted on Twitter by the account FacelessJuniorDoctor (@IRE_FJD) on 22 March. Many doctors responding to the post were critical of the HSE policy. For example, Dr Christine Kiernan tweeted “we need a national directive to protect our vulnerable front line staff, loads of non Covid patients that need to be cared for”.

There have also been concerns expressed by doctors in regards to ongoing availability of PPE, with the HSE saying it has ordered significant stock.

The Medical Independent contacted the HSE for comment on the redeployment policy.

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