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Hi Melissa,
I think this is quite a complicated situation that, from an IPC point of view, would require escalating or handing over to other areas depending on how your service works. Essentially it comes down to a workplace health and safety matter rather than IPC. Masks, respirators, and face shields are safety equipment to protect the staff member, patients, residents, and others in the facility (regardless of what type of facility). A staff member cannot be medically exempt from workplace health and safety requirements. A risk assessment could be made if the issue was only that of safety for the individual staff member, but in the case of respiratory infection the risks involve more people and risk assessments would need to be dynamic to address changing exposures. As another reply mentioned the options include furloughing the staff member during periods when they would be required to wear this PPE, or reallocating them to a role where the PPE is not required. This would need discussion at a line manager/HR level as to how this would be managed as it may or may not be possible in your situation given it is potentially a permanent move.
It is certainly a tricky situation. I think as a profession we (IPC) probably need to work with regulatory bodies (WH&S, NMBA, etc.) and other interested parties (unions, Health departments etc.) in considering healthcare worker fitness to practice where there are medical or other conditions that mean IPC practices and requirements cannot be implemented. We often focus in these situations on the needs of the healthcare worker with the impacts on those around them taking up a smaller focus, if at all. For me ethically this is challenging as I get the individual has rights as a worker and human but with those rights comes responsibilities. Should we place the medical needs of a staff member (often protected by legislation) above that of the safety of others in the facility? The recently released ethical framework from APIC and IPAC (https://apic.org/apic-ipac-canada-ethical-infection-prevention-and-control-eipac-decision-making-framework/) is a useful tool but I note doesn’t specifically address this sort of situation in it’s examples, probably due to it being so complex! That said it may be useful to use the tool to outline how could mange the situation and use I to frame discussions with decision makers in your facility.
Cheers Matt
Lecturer, Nursing
Academic Lead: Work Integrated Learning
School of Health UniSC
Ph +61 7 5456 5191 (office)
Ph 0498188039 (mobile)