Be sure practice in your organization aligns with current recommendations.
- On October 25, 2019 the Centers for Disease Control and Prevention updated various parts of the 1998 guidelines for infection control for occupational health.
- The new guideline is comprehensive and aimed at healthcare organization leaders and staff of occupational health services to facilitate infection prevention and control.
- The guidelines address controlling exposures to communicable diseases and providing effective management for exposure incidents.
On October 25, 2019, the Centers for Disease Control and Prevention (CDC) published Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services, updating various parts of the 1998 guideline. (See What’s changed?)
The updated recommendations are aimed at leaders and staff of occupational health services (OHS) and leaders of healthcare organizations, with the goal of facilitating provision of infection prevention services to healthcare personnel (HCP).
The updated guidelines are based on a systematic review of literature from January 2004 to December 2015 and an assessment of occupational infection prevention guidelines, regulations, and standards. All recommendations are classified as good practice statements based on the expert opinions of Kuhar and colleagues and the Healthcare Infection Control Practices Advisory Committee.
What follows is a quick overview of the updated guidelines in eight infection prevention and control elements of OHS.
Leadership and management
Five recommendations are presented for healthcare organization leaders and five for OHS leaders and staff. The recommendations address organizational culture, resources, and safety. (See Leadership recommendations.)
Communication and collaboration
Communication and collaboration among OHS supervisors, senior management, human resources, infection prevention services, legal departments, and HCP can encourage adherence to recommended work restrictions, promote a safety culture, provide sufficient resources to implement occupational infection prevention, and help decrease the likelihood of HCP reporting to work when they’re ill.
Assessing and reducing HCP risk for infection
Controlling exposure to occupational infection is fundamental to protecting HCP. This section reviews the hierarchy of controls—from elimination (completely removing a potential hazard) to correct and consistent use of personal protective equipment—to determine how to implement feasible and effective solutions.
One function of OHS is providing or referring HCP for preplacement and periodic medical evaluation. Among the recommendations in this section are preplacement medical evaluation (including medical examination and assessment for vaccine-preventable diseases) and health counseling (including the risk for and prevention of infection transmission to others and postexposure prophylaxis). The section also reviews the Americans with Disabilities Act (which prohibits employers from asking job applicants to undergo medical evaluations before making job offers or making pre-employment inquiries about disabilities), the Occupational Safety and Health Administration (OSHA) bloodborne pathogen standard (which requires employees to be offered hepatitis B immunizations and job-related postexposure evaluation and follow-up), and the OSHA respiratory protection standard (which requires initial and follow-up medical evaluation, fit testing, and training).
Occupational infection prevention education and training
Occupational IPC education and training programs are intended to increase HCP knowledge, competency, and skills related to communicable diseases. Recommendations include providing dedicated time for infection prevention education and training during normal working hours and collaborating with healthcare organization departments to periodically review exposure data to identify high-risk HCP populations (for example, those who work on a pulmonary unit where they may be at risk for tuberculosis) for additional training.
Immunization programs should document evidence of immunity (via vaccination history, laboratory tests, or titers), record keeping, and reporting to local and state systems such as vaccine registries. This section recommends setting goals to achieve high rates of immunization and specifies strategies to offer vaccines and gather and review information for quality improvement.
Managing potentially infectious exposures and illnesses
HCP can be exposed to potentially infectious materials via blood and bodily fluids, tissue, secretions, contaminated medical supplies, devices, equipment, environmental surfaces, splashes, and inhalation. Appropriate and effective management of exposures and illnesses include prompt assessment and diagnosis, monitoring signs and symptoms, and providing appropriate postexposure or illness management. Recommendations in this section cover exposure and illness management, work restrictions, and sick leave.
Managing HCP records
OHS collect, maintain, report, and ensure confidentiality of HCP health information. Recommendations in this section include establishing a system to maintain confidential work-related HCP records, facilitating data aggregation, and making copies of individual records so they’re quickly available to HCP upon request.
OHS is essential for the well-being of HCP working in healthcare organizations across the United States. The updated CDC guidelines provide an evidence-based framework for developing and implementing effective organization-specific policies and procedures that will help keep HCP safe and healthy. (See Be prepared.)
George Allen is director of infection prevention at Brookdale University Hospital in Brooklyn, New York.
Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health: Hierarchy of controls. January 13, 2015. cdc.gov/niosh/topics/hierarchy
Kuhar DT, Carrico R, Cox K, et al. Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services. October 25, 2019. cdc.gov/infectioncontrol/pdf/guidelines/infection-control-HCP-H.pdf
Occupational Safety and Health Administration. Occupational Safety and Health Standards: Bloodborne pathogens. osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051
Occupational Safety and Health Administration. Occupational Safety and Health Standards: Personal protective equipment: Respiratory protection. osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716&p_table=STANDARDS
United States Department of Justice. Information and technical assistance on the American with Disabilities Act. ada.gov/ta-pubs-pg2.htm