Here at Zero Hour Health, we’ve noticed a trend over the past two years. An employee chats in to say they’ve tested positive for an infectious disease like Hepatitis A. Their manager is panicking, prepping for a health inspection, and trying to figure out who can work and who needs to be sent home. But something is off - the employee doesn’t have the symptoms we’d expect to see. So we ask to see the actual test results and find what we suspected: the employee didn’t test positive for Hep A; they tested positive for Hep A antibodies.
Testing positive for antibodies just means they’ve been vaccinated or recovered from an infection in the past. Not surprising, considering almost half of all states have some sort of childcare or school Hep A vaccine requirement now, and younger staff members will have been vaccinated under those regulations.
New federal rules went into effect in April 2021 that require healthcare providers to make most test results and clinical notes available to patients immediately. And a new study shows that patients want to see their health test results immediately, even if the doctor hasn’t had a chance to review them or if it’s bad news.
Quick access to your medical information and tests can be great, especially when test results are normal, avoiding unnecessary worry. But some test results can be particularly confusing, like testing positive for Hepatitis A antibodies. On a test, a Hep A antibody result looks like a positive or abnormal result, which can lead people to assume they have an active infection.
Above is one example; the result is red, flagged as abnormal, and the only way it’s indicated as an antibody test is the letters “Ab”, which a layperson likely doesn’t understand. In reality, this test result means that this person has either had Hep A in the past or has been vaccinated.
We see this antibody versus active infection mix up happen regularly with Hep A, Hep B, measles, and even COVID. In some cases, we’ve even seen medical staff members get this wrong when they aren't familiar with interpreting results.
Another common test results issue we see is with E. coli. An employee tests positive for E. coli, but it’s not the kind of E. coli that’s a foodborne illness threat.
After seeing the results, the employee panics. They call their closest work friend and their manager, who picks up the phone and calls the local health department. Soon the whole restaurant knows they have a positive E. coli case and that they’ll be inspected any minute. But none of that needed to happen.
There are really only two types of E. coli that we’re worried about in food service (enterohemorrhagic and shiga toxin-producing) out of hundreds of strains. In reality, this employee had a UTI. They knew that but didn’t know it’s a different type of E. coli bacteria than the one they heard so much about as a restaurant worker and was trying to do the right thing. It’s not the employee’s fault, but it’s something business owners and operators need to prepare for in this new era of on-demand access to test results.
This isn’t going away anytime soon. The federal law and the proliferation of smartphone apps allowing immediate push notifications for test results mean that employees will get confusing health results instantly, sometimes while at work. Managers, especially in the restaurant and hospitality industries, need to be informed about what to look for and when to sound the alarm so that they’re not delaying action in an infectious situation where an outbreak could occur, but they’re also not panicking for no reason. Consider including information about antibody testing and important strains of E. coli as part of managers’ employee health and food safety training.
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For ZHH clients, we’re happy to help you draft this or conduct training with your managers. And if you have questions about employee results, our clinical team is available to chat in the app from 5 am to midnight, 7 days a week, and are experts in reviewing test results. They’re happy to help.