Insufficient screening of CHSLD personnel

As little as 10% of the staff of certain CHSLDs are screened for COVID on a regular basis, one of the keys to slowing the intrusion of the virus into living environments for seniors. A situation that gives some managers a hard time, studies showing that 10 to 20% of infected employees are completely asymptomatic.

While community transmission is regaining strength, only one in ten CHSLD employees of the CIUSSS de l’Ouest-de-l’Île-Montréal is currently undergoing the weekly screening recommended since July by the Ministry of Health and Social Services. to prevent transmission among seniors. And this, at a time when a CHSLD in the sector is among those in Quebec where 15% of residents are infected with the new coronavirus.

Other CHSLDs are also struggling to convince their employees to get tested regularly. According to the CIUSSS du Nord-de-Île-de-Montréal, only 20% of CHSLD employees were screened in September, and this rate has since risen to 30%. This CIUSSS, very hard hit during the first wave, even set up a reward program to increase the motivation of employees to be tested. Each employee screened 5 times in 5 weeks now receives $ 10 in gift cards, and $ 30 after 10 screenings in 12 weeks.

“It is very demanding for our staff to be tested every week. We would like to encourage them to maintain the right reflexes with creative means, ”explained a spokesperson for this CIUSSS this week.

I’m worried. More and more healthcare workers, including doctors, nurses and attendants, are letting their guard down, especially during breaks.

At the CIUSSS de l’Ouest-de-l’Île-de Montréal, where outbreaks hit two CHSLDs, including that of the Floralies de Lachine where 15% of residents are infected, we are also looking to find ways to increase starvation rates. preventive screening. At the CIUSSS du Center-Sud-de-l’Île-Montréal, where two CHSLDs are struggling with outbreaks, 40% of employees underwent tests from mid-August to mid-September, and 45% in October. But the lack of enthusiasm of workers to participate in these preventive measures is worrying.

” I’m worried. More and more healthcare workers, including doctors, nurses and attendants, are letting their guard down, especially during breaks. Today I was alone for dinner in a room. Five workers came in and stayed for an hour to chat during the lunch with the mask under the chin, ”confided to Duty a doctor, anynome, of the opinion that instructions and screening in the workplace should be strengthened.

“Our employers tell us it’s hard, but honestly I doubt gift cards make a difference. It is a procedure that employees find invasive. We need saliva tests, faster. But for the moment, they are not as reliable as swab tests ”, affirms Kathleen Bertrand, president of the FIQ – Union of nursing professionals of the North of the Island of Montreal, including more than 646. members have been infected since the start of the pandemic.

Johanne Riendeau, president of the FIQ-Union of West Island Healthcare Professionals, recognizes that many employees abstain, not out of bad faith, but because repeated withdrawals are very irritants. “When it’s been 15 times since people take the test, they are definitely less motivated,” she says.

Lots of asymptomatic

Certainly, the high percentage of asymptomatic employees is a major problem in preventing outbreaks in healthcare systems, here and elsewhere in the world.

To know everything about COVID-19

Professor Tauland Muka, head of the research group at the Institute for Social and Preventive Medicine (ISPM) at the University of Bern in Switzerland, has just published a meta-analysis in The American Journal of Epidemiology which establishes the proportion of asymptomatics among 230,000 health workers in 24 countries at 40%, in 97 studies. “This included people who were asymptomatic at the time of the test, who fell ill later. But the potential for silent transmission by these workers and those who are completely asymptomatic presents a huge challenge for all health systems, ”said Dr.r Muka, at Duty.

“We need to test more preventively. Rapid saliva tests are going to be a real game-changer in controlling the epidemic, ”he says. A study published in PLOS ONE by one of his colleagues quantifies the proportion of workers who remained asymptomatic throughout their infection at 20%.

Alain Talbot, professor in the department of social and preventive medicine at Laval University, who has reviewed hundreds of studies on the subject on behalf of the INSPQ, also concludes that the most credible estimate that 10 to 20 % of infected people remain completely asymptomatic.

This would mean that among the 17,000 workers in the Quebec health network declared positive for COVID, several thousand came to work without symptoms. Professor Talbot adds, however, that asymptomatic workers are less contagious than workers in the “presymptomatic” phase, who end up developing symptoms between two and four days after being tested positive. “What is clear is that asymptomatic people seem to be less at risk of transmitting the virus, up to 2 to 3 times less than those who are in the presymptomatic phase,” he says. If we already succeeded in isolating presymptomatic people, we would act on a large part of the epidemic. “

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