Worker faced exposure to infection as a hospital patient and in recreational activities
An Ontario healthcare worker has lost his appeal for worker’s compensation benefits for an infection he contracted because the Ontario Workplace Safety and Insurance Appeals Tribunal found it was likely he contracted it through non-work-related exposure.
The 40-year-old worker was employed as a transporter and service assistant at an Ontario hospital. He was initially hired in 2009 and moved into the transporter/service assistant job two years later. In that position, he worked on various floors of the hospital cleaning, mopping, sweeping, taking out garbage, wiping services, disinfecting 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, documents, and deceased patients.
On one of the floors where the worker performed his duties, there were sometimes patients with methicillin resistant staphylococcus aureus (MRSA), a bacteria resistant to many antibiotics that can cause various infections of the skin and bloodstream, as well as pneumonia and sepsis. He always followed safety protocol on this floor, which included preparing everything outside the room and putting on personal protective equipment (PPE) — before entering 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 frequently. When working in the emergency ward or transporting patients, he wore full PPE regardless 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 performed some tests and sent him home. The next day, the hospital informed him he had cellulitis caused by MRSA and should return 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 antibiotics himself three times a day. He was off work recovering for almost three months.
Workplace exposure
The worker applied for workers’ compensation benefits for his time off work due to occupational exposure to MRSA that led to his cellulitis. He admitted that it was possible he had cellulitis 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 certain 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 patients, and he presented a medical discussion paper that stated MRSA is most commonly contracted from the hands of healthcare workers.
The Ontario Workers Safety and Insurance Board and an appeals resolution officer both denied the worker’s claim as the evidence didn’t support that the worker’s cellulitis was from MRSA developed from occupational exposures. The worker appealed to the tribunal.
The tribunal referred to a medical article that defined two types of MRSA — healthcare-associated and community-associated. The former was contracted through exposure to other contaminated patients or devices, while the latter was contracted through exposure to others with it in community settings — including sports teams. However, as far as the nature of the infection went, there was no distinction between the two types.
The article also noted that healthcare-associated MRSA was commonly transmitted through contaminated hands of healthcare workers or environmental surfaces, while community-associated MRSA was transmitted through direct contact with infected individuals or their contaminated objects. Transmitters of the infection could be asymptomatic.
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 participating 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 cellulitis to occupational exposures.
The worker’s family doctor reported 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 medical 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 specialist 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 specialist speculated that “the most likely scenario is that he actually acquired this MRSA organism while he was admitted as an inpatient at (the hospital).”
The tribunal determined that it was not possible to determine with certainty where and how the worker contracted the MRSA that caused his cellulitis. 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 evidence that demonstrated its likely cause was occupational exposure to the infection.
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