Canadian Safety Reporter

2 Canadian HR Reporter, a Thomson Reuters business 2018 CSR | January 2018 | News mopping, sweeping, taking out garbage, wiping services, disin- fecting beds, changing linens, wiping down beds, and cleaning patients' rooms. He also moved patients around the hospital and between the hospital and a neighbouring facility through an underground tunnel, as well as transported specimens, docu- ments, and deceased patients. On one of the floors where the worker performed his du- ties, there were sometimes pa- tients with methicillin resistant staphylococcus aureus (MRSA), a bacteria resistant to many an- tibiotics that can cause various infections of the skin and blood- stream, as well as pneumonia and sepsis. He always followed safety protocol on this floor, which included preparing ev- erything outside the room and putting on personal protective equipment (PPE) — before en- tering the room. The PPE was disposed of immediately and hands washed after leaving a room with an MRSA patient. The worker also wore gloves at all times when working on any floor and washed his hands fre- quently. When working in the emergency ward or transporting patients, he wore full PPE regard- less of the patient's ailment. On Dec. 10, 2012, the worker noticed an abscess on the side of his torso that was causing him discomfort and looked red and puffy. He went to the emergency department, where doctors per- formed some tests and sent him home. The next day, the hospital informed him he had cellulitis caused by MRSA and should re- turn immediately to be placed in isolation. A doctor drained the abscess and placed him on intravenous antibiotics. After two days, he was sent home with a portable pump to administer the antibiot- ics himself three times a day. He was off work recovering for al- most three months. Workplace exposure The worker applied for work- ers' compensation benefits for his time off work due to occu- pational exposure to MRSA that led to his cellulitis. He admitted that it was possible he had cellu- litis in November 2011 when he was treated for a red and swollen right hand after being hit with a hockey stick while playing ball hockey — he played the sport two-to-three times per week all year round. He was treated with antibiotics and was off work for about 30 days. The worker also was treated for a nasal blister in March 2011 and had mentioned on a couple of occasions to doctors that he had staph infections in the past. When he played ball hockey, he and the other players used a dressing room and shower, as the worker also did when he played racquet ball and squash, worked out at a gym, and swam at a local pool. In his workers' compensation claim, the worker admitted that he couldn't be completely cer- tain that his cellulitis was work- related, but he hadn't contracted it before working in the hospital — there was no evidence he had it before December 2012 — he worked on a floor with MRSA pa- tients, and he presented a medi- cal discussion paper that stated MRSA is most commonly con- tracted from the hands of health- care workers. The Ontario Workers Safety and Insurance Board and an ap- peals resolution officer both denied the worker's claim as the evidence didn't support that the worker's cellulitis was from MRSA developed from occupa- tional exposures. The worker ap- pealed to the tribunal. The tribunal referred to a medical article that defined two types of MRSA — healthcare-as- sociated and community-associ- ated. The former was contracted through exposure to other con- taminated patients or devices, while the latter was contracted through exposure to others with it in community settings — in- cluding sports teams. However, as far as the nature of the infec- tion went, there was no distinc- tion between the two types. The article also noted that healthcare-associated MRSA was commonly transmitted through contaminated hands of healthcare workers or environ- mental surfaces, while commu- nity-associated MRSA was trans- mitted through direct contact with infected individuals or their contaminated objects. Transmit- ters of the infection could be as- ymptomatic. The tribunal found that the worker had risk factors with all possible modes of transmission — working in a hospital, being a patient in a hospital, and partici- pating in regular sports activities. And it was important to note, the tribunal said, that none of the doctors who treated the worker attributed his MRSA and celluli- tis to occupational exposures. The worker's family doctor re- ported that he was "unable to say for certain" what the cause of the worker's condition was, and the doctor who treated he worker's abscess in December 2012 stated that "there is no objective medi- cal information to demonstrate the condition was caused by his work" and the worker had a past history of skin abscess formation and cellulitis. An infectious disease special- ist who treated the worker a few months after his abscess also reported that there was no way of saying whether the worker contracted the infection at the hospital or during recreational time, and if the worker did catch it at the hospital, it couldn't be said whether it was while he was working there or was there as a patient. In fact, the special- ist speculated that "the most likely scenario is that he actually acquired this MRSA organism while he was admitted as an inpa- tient at (the hospital)." The tribunal determined that it was not possible to deter- mine with certainty where and how the worker contracted the MRSA that caused his celluli- tis. Though the worker argued occupational exposure was the "most plausible explanation," the tribunal disagreed based on the medical opinions. The tribunal dismissed the worker's appeal for entitlement to workers' compensation benefits for his cellulitis over a lack of evi- dence that demonstrated its likely cause was occupational exposure to the infection. For more information see: • Decision No. 2799/17, 2017 CarswellOnt 14856 (Ont. Workplace Safety & Insurance Appeals Trib.). Healthcare < pg. 1 Worker had risk factors with all possible modes of transmission Credit: Shutterstock/J nata-lunata

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