Infection preventionists who work closely with employee health colleagues — or wear the proverbial “two hats” for both jobs — should be aware that the CDC is updating its 1998 “Guideline for Infection Control in Healthcare Personnel.”
A draft version recently discussed at a meeting of the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) calls for administrators and leaders of healthcare organizations to regularly review results of risk assessments related to occupational infection prevention, set performance goals, and reduce risks.
Employee health leaders and staff would conduct the risk assessments or collaborate with IP colleagues to identify and reduce occupational infectious threats to workers. As recommended in the CDC draft, they would also participate in committees and decision-making processes that affect occupational infection prevention efforts. These teams would then advise colleagues and administrators on risk reduction strategies and other occupational infection prevention issues.
“The real challenge in this is the diversity in how occupational health services are provided out there,” says David Kuhar, MD, a medical officer in the division of healthcare quality promotion at the CDC. “Larger healthcare organizations might have an onsite group that provides this for the organization, but small freestanding facilities may contract their services from a provider that is not part of their organization. The diversity in these services means that not all occupational health providers have access to the facility and [employee] data. We wanted to be careful to not inappropriately place ownership of, for example, walking through a workplace to assess it for safety, when they may be a contracted offsite health service. However, they could be asked to do it, so we wanted to be sure that we framed the recommendations in a way that was sensitive to those that might not have the access to provide those services.”
A section on conducting medical evaluations of healthcare workers has also been expanded and is more prescriptive in terms of recommendations. For example, the draft guidelines emphasize the importance of “pre-placement” medical evaluations to be done after a worker is hired, but before they are assigned to a specific duty or area in the hospital. These exams would include looking for any immunity problems, pregnancy, or other conditions in the worker, as well as the risk of infections associated with their designated duties.
“We highlighted the importance of the pre-placement evaluation,” Kuhar says.
“This is after the person is hired but before they actually start their job duties. They have a medical evaluation to address their risks of acquiring or transmitting infections at work as well as to address their evidence of immunity and possible need for immunizations before they set foot on the wards.”
These exams would be followed by periodic and “episodic” medical evaluations, with the latter most likely occurring in the context of an exposure or outbreak.
“We also wanted to highlight the need for periodic evaluations, there might be planned repeated visits to the occupational health clinic, as well as the episodic ones — say, when an exposure has happened,” he says. “We wanted to offer much more specific guidance as to the types of medical evaluations that occupational health services typically provide.”
The first sections of the draft are expected to open for review and comment in the coming months, he notes. The revisions will be comprehensive in some areas because the last version of this guideline is now 19 years old.
“Since 1998, quite a lot has changed, and among those changes were several new regulations that affected occupational health services to personnel,” Kuhar says. “There were new OSHA standards, like the respiratory protection standard, that require training as well as education for workers who have to use respirators as part of their work duties. The other issue is there are a lot of requirements from accreditation and federal agencies, like CMS [requiring] reporting of healthcare influenza immunization rates.”
The assessment and reduction of infectious risks to staff is also getting a new emphasis.
“We are proposing a more extensive medical evaluation section. However, I would say that what you might do in a medical evaluation has not changed drastically since 1998. There are more requirements that affect how we do a medical evaluation, and we added more detail on the type of medical evaluations that occupational health service might provide.”
The CDC guideline will not likely get into great detail into common PPE woes like lack of compliance with respirator use or fit testing.
“I would say that is probably an issue for a different guideline — more related to the effectiveness of infection control measures,” Kuhar says. “What we wanted to do here is highlight the role that occupational health services might play in facilitating readiness to use a respirator. You use your pre-placement medical evaluations to assess a provider’s ability to use a respirator in compliance with OSHA requirements.”