New guidelines to prevent infections in healthcare workers will expand beyond the hospital to include outpatient settings, according to the CDC.
As outlined at a March 31, 2016, meeting of the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), the guidelines will address occupational infectious threats in outpatient settings, clinics, ambulatory surgery centers, home healthcare, non-acute care inpatient facilities and long-term care. The plan is to address both on- and offsite occupational health services, including contracted services.
“I’m really excited that guideline is going to cover the continuum of care — not just focus on hospitals,” says Connie Steed, MSN, RN, CIC, director of infection prevention at Greenville (SC) Health System, and an advisor to HICPAC on the guidelines. “It is going to look at the continuum and other healthcare environments, which I think is very important.”
The new guidelines will include overall program elements and protecting workers from a broad range of infectious agents, though it may be somewhat of challenge to translate all aspects to ambulatory care.
“It will be a challenge, but it needs to be done,” Steed says. “This hasn’t been updated in a long time and healthcare now is delivered in so many different forms, and we need to be sure that those are addressed, too. I’m really pleased that they are doing that.”
The CDC is updating guidelines for “Infection Prevention in Healthcare Personnel,” which were originally published in 1998 when much more care was delivered in hospitals.
“The locations where care is delivered are changing rapidly,” says Ruth Carrico, PhD, RN, CIC, assistant professor of health promotion and behavioral sciences at the University of Louisville (KY).
Carrico, a former HICPAC member who is serving as an advisor on the guidelines, emphasizes it won’t be as easy as saying, “‘Here is an occupational health program that can be implemented any place.’ I think we need to take a step back and say, ‘What is the framework that will address the need in any setting where care is delivered?’ We are trying to make sure wherever care is delivered that we are recognizing the risks to healthcare workers and figuring out a process to minimize those risks.”
In addition to specific pathogens, many of which will be updated from the 1998 version, the new CDC guidelines will be a “living document” that will be updated electronically. In that regard, the plan is to post the sections of the new guidelines sequentially as they are completed and approved by HICPAC, says David Kuhar, MD, a medical officer in the division of healthcare quality promotion at the CDC.
The first section will outline the baseline infrastructure and routine practices of occupational health service. The proposal is to include descriptive text plus hyperlinks to supplementary materials that can be updated over time (e.g., immunizations on hire for HCWs). The second section will focus on epidemiology and prevention of selected infections as well as protection of special healthcare worker populations (e.g., pregnant, immune compromised, and those temporarily working outside the U.S.).
“We are updating a small section at a time so that parts of it will come out in sequence,” Kuhar says. “So the first section, which I presented at HICPAC, we are planning to have the committee review some drafts in July. I think the changes that are required will really determine the timeline of when it gets posted online. Each time we finish a section we will take up another one and post them sequentially.”
While a series of emerging infections in this young century — from SARS to Zika — underscore the ever-changing threat to healthcare workers, the updated CDC guidelines will focus more on the longstanding day-to-day threats and broaden the umbrella of protection beyond hospitals.
“These emerging pathogens require unique considerations for healthcare worker safety and that’s why when they emerge there are specific guidelines developed for, say, PPE for healthcare workers with Ebola or a separate infection control guideline for MERS-CoV,” Kuhar says.
Though they will continue to be addressed in separate guidelines, the recurrence of new infectious threats stresses the importance of flexibility in employee health programs.
“The employee health function has to be agile enough that there is an ability to respond to whatever comes up,” Carrico says. “I think this is an opportunity to really look at our programs and say, ‘What are doing well, what are not doing well, and how do we need to change?’”
The recommendations will be aimed at healthcare administrators who oversee occupational health services as well as the leaders and staff of the programs.
“I think a lot of it is refreshing the information that was in there previously, but also just as we have information about what constitutes an infection prevention and control program there will be an effort to do something very similar with the employee health and occupational health program,” Carrico says. “This really is a program that is important if we are looking at protecting the healthcare workforce. Watching what happened with Ebola really brought that forward. We need to develop a greater and more organized appreciation for the occupational health function [in healthcare.]”
Of course employee health professionals deal with non-infectious challenges like back injuries and ergonomic issues, but the infection control aspect of the job has taken on a greater urgency in the aftermath of Ebola.
“There is a very strong infectious diseases component,” Carrico says. “We need to make sure that is very clear and that there is a methodology for investigating, monitoring, and follow-up of these kind of issues. In a patient care setting the healthcare workers themselves can be involved in transmission. So it becomes a unique situation to try to look at transmission in both directions: to the healthcare worker and to the patient.”
