Health Care Workers, Including Public Health Researchers & Medical Laboratorians

Risks For Health Care Workers Practicing During Travel Outside the United States

Health care workers practicing outside the United States face unique health hazards, including infectious disease risks associated with patient contact or handling clinical specimens. Any type of health care worker working in clinical areas or handling specimens may be at risk, including physicians, nurses, ancillary clinical staff, trainees (for example, students on international rotations), researchers, and public health workers.
Health care workers can be exposed to infections spread through blood and bodily fluids (such as HIV or hepatitis B) or through airborne or respiratory droplet routes (such as tuberculosis [TB] or influenza). Risks vary depending on the duties of the worker, the geographic location, and the practice setting. Of note, health care workers working overseas can have increased risk of exposure to patients with certain uncommon, highly pathogenic, or emerging infectious diseases such as extensively drug-resistant tuberculosis (XDR-TB), Middle East respiratory syndrome (MERS), and Ebola virus disease.
Risks encountered while performing medical work outside the United States can be due to multiple factors, including:
  • Less stringent safety regulations or infection control standards.
  • Limited availability of personal protective equipment (PPE), safety-engineered devices, or postexposure management resources.
  • Unfamiliar practice conditions, equipment, or procedures.
  • Challenging practice conditions that can prevent providers from adhering to standard precautions (such as extremely resource-limited settings, natural disasters, or conflict zones) (see Box 9-1).
  • Higher prevalence of transmissible infections (such as HIV, hepatitis B virus [HBV], hepatitis C virus [HCV], or TB), with potentially increased transmission risk from untreated source patients.

Box 9-1. Health care workers in extreme circumstances

Health care workers regularly provide care in a range of extreme circumstances, which may be characterized by: limited or absent medical and public health infrastructure; lack of fundamental hygiene supplies (such as soap and water for handwashing); increased infectious disease transmission; extreme environmental conditions; and high levels of violence. In 2016, there were 158 attacks against aid workers; 101 were killed.
Because of these increased risks and consequences of severe disease or injury, adequate prevention and preparation are essential. Health problems for the health care worker can have serious implications, both for the person and for those who depend on the health care worker for provision of health care. Detailed instructions on how to prepare for travel or work in developing countries or humanitarian environments is covered in detail in other sections, but additional key considerations for the health care worker include:
  1. Having reliable communication equipment: usually satellite phone, ensuring service provider contract for duration of the mission. Consider portable solar recharging capabilities unless there is a guaranteed power supply, which is rare in most extreme circumstances.
  2. Acquiring evacuation insurance and having a plan if ill or injured: deploying organizations may not provide evacuation insurance (see Chapter 6, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance) or a detailed evacuation contingency plan. However, both are critical, and the health care worker should be familiar with all details.
  3. Considering underlying health conditions: the provider’s health should be monitored closely and treatment initiated early, if necessary. Any indication that a potentially serious condition is not responding to treatment should warrant rapid planning for potential medical evacuation.
  4. Being psychologically stable and knowing whom to contact if problems arise: providers in conflict and disaster zones typically work long hours in dangerous conditions and are exposed to profound suffering. These experiences can be intensely stressful, leading to increased rates of depression, posttraumatic stress disorder, and anxiety. Before deployment, providers should think about coping strategies and, as much as possible, stay in contact with a support network of family and friends.
  5. Inquiring about availability of antidotes to chemical warfare: although rare, health care workers may be exposed to chemical warfare agents while caring for patients, as recently documented in Syria. If exposure to these agents is a possibility, antidotes (such as atropine) should be immediately available.

There's more to see -- the rest of this topic is available only to subscribers.