Occupational infection prevention: Updated recommendations

Authosr(s): George Allen, PhD, RN, FAPIC, CIC, CNOR

infection prevention

Be sure practice in your organization aligns with current recommendations.

Takeaways:

  • 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).

What's changed?

The Centers for Disease Control and Prevention’s Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services includes updates to four sections of part I of the 1998 guidelines and corresponding recommendations in Part II:

C. Infection control objectives for a personnel health service
D. Elements of a personnel health service for infection control
H. Emergency response personnel
J. The Americans with Disabilities Act.

All other sections of the guideline remain unchanged.

The updated sections describe the infrastructure and routine practices of occupational health services (also called employee health services, employee health, or occupational health) in providing infection prevention services to healthcare personnel. The updates also describe special considerations associated with emergency response personnel and provisions in the Americans with Disabilities Act relevant to occupational health.

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.

Leadership recommendations

The new guidelines include specific recommendations for healthcare organization leaders and occupational health services leaders and staff.

Healthcare organization leader recommendations

  • Invest in an organizational culture that prioritizes safety and occupational infection prevention.
  • Regularly review organizational information about occupational infectious risk, exposures, and illnesses with occupational health services.
  • Dedicate one or more persons with appropriate authority and training to lead occupational infection prevention services.
  • Provide sufficient resources (e.g., expertise, funding, staff, supplies, information technology) to implement elements of occupational infection prevention: leadership and management, communication and collaboration, assessment and reduction of risks for infection among healthcare personnel (HCP) populations, medical evaluations, occupational infection prevention education and training, immunization programs, management of potentially infectious exposures and illnesses, and management of HCP health records.
  • Oversee, and include occupational health services leaders in, performance measuring and continuous quality improvement activities for occupational infection prevention services.

Occupational health services leaders and staff

  • Promote an organizational culture with a consistent focus on safety and occupational infection prevention.
  • Develop occupational infection prevention services that are tailored to the needs of HCP and the environment in which they work.
  • Develop, review, and update when necessary written policies and procedures that adhere to federal, state, and local requirements for elements of occupational infection prevention services: leadership and management, communication and collaboration, assessment and reduction of risks for infection among HCP populations, medical evaluations, occupational infection prevention education and training, immunization programs, management of potentially infectious exposures and illnesses, and management of HCP health records.
  • Inform all HCP and relevant healthcare organization departments about occupational infection prevention and control policies and procedures.
  • Collaborate with appropriate healthcare organization departments and individuals to achieve goals, including compliance with regulations related to occupational infection prevention and control, development of infectious disease emergency and outbreak management plans, development and monitoring of performance measures, setting and meeting quality improvement goals, and assessment of infection prevention and control services.

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.

Medical evaluations

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

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.

Be prepared

Healthcare organizations should be prepared to implement the following items to ensure they comply with the updated Centers for Disease Control and Prevention occupational infection prevention recommendations.

  • Protocols should be established so occupational health services can address communicable disease transmission, workplace hazards (such as falls), patient-handling injuries, chemical exposures, burnout, and workplace violence.
  • Although dental, autopsy, and clinical laboratory personnel aren’t included in these recommendation, both paid and unpaid individuals (for example, volunteers, students) serving in the setting should participate in the program.
  • The term “healthcare settings” isn’t limited to acute care settings, long-term care facilities, inpatient rehabilitation facilities, nursing homes, and assisted living facilities. It also now includes home healthcare, mobile clinics, and outpatient facilities such as dialysis centers and provider offices.
  • Senior leadership should establish oversight, administrative support, and resource allocation for occupational infection prevention.
  • Performance measures should be used to track occupational infection prevention services and guide quality improvement initiatives.

Essential services

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.

References

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

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