As previously reported in Hospital Infection Control & Prevention, the spread of Zika virus in the U.S. calls for rigorous compliance with standard precautions and sharps safety in healthcare settings. Federal agencies recently reiterated these points in new guidelines to protect healthcare workers from acquiring Zika on the job.
As of May 4, 2016, public health officials were reporting 472 travel-associated Zika virus disease cases. There were no locally acquired vector-borne cases, but 10 cases were sexually transmitted. In addition, 44 of those with Zika in the U.S. were pregnant. There was one case of Zika-related Guillain-Barré syndrome (GBS). In contrast, U.S. territories were being heavily hit by local mosquito transmission, with only three of 658 cases related to travel. In addition, 59 pregnant women have been infected and there were five cases of GBS.
While Zika is primarily a public health threat via mosquitoes, the severe birth defects associated with the infection may give pause to healthcare workers who are pregnant or trying to become so, particularly if their patient care duties involve exposure to blood and frequent use of sharps. Though it may provide little comfort, it should be noted that Zika infection progression does not always result in birth defects. Still, in terms of managing risk and avoiding adverse outcomes, it’s hard to imagine a more emotionally charged situation than an expectant nurse balancing work demands against protective maternal instincts.
Though most Zika cases are asymptomatic, the virus may be present in the blood for approximately one week. That sets up a scenario for transmission via mosquito bites as travelers returning from areas of ongoing transmission serve as reservoirs for subsequent victims of the same mosquitoes. Aedes mosquitoes capable of transmitting Zika virus are expected to be present in some 30 states by mid-July. The infection risk is primarily in the community, but the situation warrants vigilance to basic precautions in healthcare as those with the virus in their blood become patients seeking treatment for day-to-day maladies, elective surgery, chronic illnesses, and emergencies.
“There have been no reports yet of transmission of Zika virus to healthcare personnel or other patients,” says Jill Shugart, MSPH, REHS, assistant program coordinator at the National Institute of Occupational Safety and Health (NIOSH). “Minimizing exposures to body fluids is important to reduce the possibility of transmission, but there have not been documented reports as of today [April 27, 2016]. Healthcare personnel should adhere to standard precautions in every healthcare setting: the normal precautions we take to prevent exposures to blood and body fluids that might transmit an infectious agent.”
A branch of the CDC, NIOSH recently issued Zika occupational health guidelines1 in conjunction with OSHA, reiterating and emphasizing the following exposure control and sharps safety measures for healthcare settings:
- Follow workplace standard operating procedures (e.g., workplace exposure control plans) and use the engineering controls and work practices available in the workplace to prevent exposure to blood or other potentially infectious materials.
- Do not bend, recap, or remove contaminated needles or other contaminated sharps. Properly dispose of these items in closable, puncture-resistant, leakproof, and labeled or color-coded containers.
- Use sharps with engineered sharps injury protection to avoid sharps-related injuries.
- Report all needlesticks, lacerations, and other exposure incidents to supervisors as soon as possible.
Healthcare workers should use standard precautions during patient care regardless of suspected or confirmed Zika infection status, the agencies recommend. However, employers should consider enhanced precautions in situations where workers are at increased risk of exposure to Zika virus or other hazards.
“While there is no evidence of Zika transmission through aerosol exposure, minimizing the aerosolization of blood or body fluids as much as possible during patient care or laboratory tasks may help prevent workers from being exposed to other pathogens,” the guidelines state. Additional protections, including engineering controls to ensure containment of pathogens or enhanced PPE to prevent or reduce exposure, may be necessary during any aerosol-generating procedures or other such tasks, the agencies recommended.
The new Zika occupational guidance stresses that healthcare workers understand the risks and routes of exposure and take standard methods to prevent transmission. Workers should be trained to seek medical evaluation if they develop symptoms of Zika. About one out of every five people infected with the virus develop symptoms, usually beginning 2-7 days after the bite of a mosquito carrying the virus. Symptoms are usually mild and can last up to a week. The most common symptoms are fever, rash, joint pain, and red or pink eyes. Other symptoms include muscle pain and headache. These symptoms are similar to those of dengue fever or chikungunya.
Ensure that workers receive prompt and appropriate medical evaluation and follow-up after a suspected exposure to Zika virus, NIOSH and OSHA recommend. If the exposure falls under OSHA’s bloodborne pathogen standard, employers must comply with medical evaluation and follow-up requirements in the standard. Zika is not spread by contact, but it can be spread sexually and safe precautions are advised if either partner has potentially acquired the virus. There are no special measures recommended for pregnant healthcare workers in the new guidelines, though a section on “outdoor workers,” raises the issue of asking for reassignment indoors.
“We wrote this guidance to both employees and employers, and we want to make sure that both groups have the right information,” Shugart says. “Certainly pregnant healthcare workers or anyone who is concerned about Zika should talk to their supervisors. We do recommend that employers train the workers about the risk and working in those environments.”
A separate CDC guideline2 on research laboratory workers states that “the involvement of pregnant workers in studies with Zika virus should be minimized.” For general workers in clinical labs, the CDC recommends that specimens from patients suspected of having Zika virus infection should be handled in accordance with standard precautions that include gloves, a laboratory gown or coat, and eye protection. In general, Biosafety Level 2 precautions are appropriate for the handling of Zika specimens. Laboratories should perform a risk assessment to determine if there are certain procedures or specimens that may require higher levels of biocontainment. For example, potential aerosol-generating procedures should be performed in a biological safety cabinet, the CDC recommends.