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Rheumatology expertise in advising immunocompromised healthcare workers: Insights from a survey of Australian rheumatologists

  • Dana Yen Lin Lee
    Affiliations
    Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
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  • Marian Makary
    Affiliations
    Department of Rheumatology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
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  • Anne Powell
    Correspondence
    Corresponding author. Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne VIC 3004, Australia.
    Affiliations
    Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia

    Department of Rheumatology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
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      Highlights

      • Most rheumatologists manage immunocompromised healthcare workers (HCW).
      • The expectation remains with specialists to advise HCW on managing workplace infection risks.
      • There remains a level of discomfort amongst rheumatologists in providing these recommendations.
      • Colleagues were the most common source of guidance for managing immunocompromised HCW.
      • Frameworks needed to guide clinicians in making recommendations for immunocompromised HCW.

      Abstract

      Background

      Healthcare workers (HCW) with an inflammatory disease may be at increased risk of infections and their complications, however there is no evidence to guide specific measures to reduce the risk of immunocompromised HCW acquiring infection in the workplace. This cross-sectional study aimed to define the attitudes of rheumatologists and rheumatology trainees towards counselling immunocompromised healthcare workers about additional workplace precautions to minimise workplace risk of infection.

      Methods

      A cross-sectional survey was administered via Zoom poll during a webinar held in August 2020. Participants were Victorian and Tasmanian members of the Australian Rheumatology Association, which includes consultant rheumatologists and rheumatology trainees. Descriptive statistics were used to analyse survey responses.

      Results

      Of the 52 participants, 41 provided care to at least one immunocompromised healthcare worker. 21 out of 52 participants estimated that the majority of these patients sought their advice about infection risk in the workplace. The most common source of information for counselling patients on workplace infection risks were colleagues (38/50). Participants were most confident in providing information on influenza and hepatitis but less confident in providing information in tuberculosis, shingles and COVID-19. Most participants believed employers of immunocompromised HCW should play a role in providing advice on managing infection risks in the workplace.

      Conclusion

      Our study reveals a level of uncertainty and discomfort amongst rheumatologists in providing recommendations to immunocompromised healthcare workers about managing their workplace risk of infection. We recommend the development of a framework to guide the clinician in making individualised recommendations for immunocompromised HCW.

      Keywords

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