Preventing infections in both healthcare workers and patients is a mission so complementary that in some small facilities, it is done by the same person. There are separate departments in larger facilities, but the goal is still centered on the idea that patient safety and employee health are two sides of the same coin.
“They are not mutually exclusive, and that is a very important point,” says David Kuhar, MD, of the CDC’s Division of Healthcare Quality Promotion. “Transmission of diseases between personnel and patients is a two-way road that requires safety measures for both. Just doing one or the other is never enough.”
The CDC has issued draft guidelines1 for preventing infections in healthcare workers, urging collaboration between infection preventionists and employee health professionals. The guidelines, which are open for comment through Dec. 14, recommend that occupational health services (OHS) engage administration and other departments in infection prevention activities.
“Explicit communication and collaboration between OHS and other departments, particularly infection prevention and control services, can improve healthcare personnel safety,” the CDC states in the guidelines.
Treatment and containment of occupational infections can protect patients and co-workers, the CDC notes. Infections acquired in the community also are a concern, particularly if workers come to work sick, as reflected in the widely reported issue of “presenteeism.” (See related story, page 141.)
“The updated recommendations in the draft guideline are intended to facilitate the provision of occupational infection prevention and control services to healthcare personnel and to prevent transmission of infections between healthcare personnel and others,” the CDC stated.
The CDC is seeking a balanced approach in the infection control guidelines for healthcare workers, trying to avoid overkill without sacrificing the necessary protections for a broad range of pathogens.
“In this draft, we include examples of performance measures that could be used to measure the effectiveness of occupational infection prevention services,” Kuhar says.
“They are examples only, because there is a lot of diversity in how these programs are delivered. But these are some tangible ideas of measures they could use to track how well their program is doing.”
For example, performance measures could include tracking the number of healthcare workers who sustain potentially infectious exposures through sharps injuries, splashes to mucosal membranes, or inappropriate use of personal protective equipment.
The CDC guidelines also cite other measures of performance, including the proportion of workers given preplacement medical evaluations, screened periodically for latent tuberculosis infection, and trained and fit-tested to use N-95 respirators.
The guidelines are geared toward routine infectious disease threats to workers, not emerging pathogens like Ebola, Kuhar says. Those outbreak situations are characterized by a lot of unknowns and can raise issues that could put worker safety and patient safety at apparent odds.
This was seen to some extent with the mask-respirator debate during the 2003 SARS outbreak, as well as the PPE issues during the 2014 Ebola outbreak. Both of those outbreaks resulted in infected healthcare workers.
These emerging infection situations are an “additional challenge to the relationship” between IPs and employee health, Kuhar notes.
“Sometimes, modes of transmission aren’t well established for these pathogens of high consequence,” he says.
Thus, a healthcare system might elect to handle exposures differently to facilitate access to occupational health services, he adds.
“This guideline does not address emerging or high-consequence pathogens,” he says.
“Services and procedures different from the norm very well may be needed for those pathogens. That’s where the boundary is drawn on this document.”
Noninfectious adverse occupational events also are beyond the scope of the document, with the CDC deferring to its NIOSH branch to provide guidance on issues like workplace violence, patient handling injuries, and slips, trips, and falls, he says.
To review the CDC draft and submit an electronic comment, go to: https://bit.ly/2Sx5ZNb.
- CDC. HICPAC: Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (Draft Guideline). Oct. 15, 2018. Available at: https://bit.ly/2JsbUPF.