HICPAC to publish new employee health guideline

Key program components outlined in draft

New guidelines to prevent occupational infections in health care workers are nearing completion by the Centers for Disease Control and Prevention’s Hospital Infection Control Practices Advisory Committee — the first comprehensive update of such policies in 15 years.

Publication of a draft version of the guidelines is expected to follow HICPAC’s final review and discussion of the guidelines at a June meeting at the CDC. The document will outline employee health measures to prevent a wide variety of occupational infections and address the issue of latex allergies in health care workers. In addition to emphasizing the importance of infection control education on such issues as hand washing and the importance of complying with recommended measures, the draft HICPAC currently is discussing cites several other essential components needed in such programs. Key aspects are summarized as follows:

Coordinated planning and administration

• Coordinate policy-making and planning among the hospital administration, personnel health service, infection control program, clinical services, various other hospital departments, and relevant external agencies. Include volunteers, trainees, contractual personnel, and emergency responders in the plan.

• Develop written policies for notifying the infection control program of infections in personnel (including volunteers, trainees, contractual personnel, and emergency responders) that require work restrictions or exclusion from work; clearance for work after an infectious illness that required work restrictions or exclusion; other work-related infections and exposures; and when appropriate, results of epidemiologic investigations.

• Assign a representative of the personnel health program to be on the hospital’s infection control committee.

Placement evaluation

• As soon as personnel who will have patient contact are hired or given a new work assignment, obtain the personnel’s health inventory. Include in the inventory the following: health worker’s immunization status; history of any conditions that may predispose the health worker to acquiring or transmitting infectious disease, for example, a history of such childhood diseases as chickenpox, measles, mumps, and rubella; history of having high-risk characteristics or conditions for, symptoms of, exposure to, or treatment for, tuberculosis; history of hepatitis or jaundice, dermatologic conditions, chronic draining infections or open wounds; and immunodeficient conditions.

• For infection control, perform directed physical and laboratory examinations on personnel, as may be determined from results of the health inventory. Include examination to detect conditions that may increase the likelihood of transmitting disease to patients, or unusual susceptibility to infections, and to serve as a baseline for determining whether any future problems are work-related.

• Conduct personnel health assessments other than placement evaluations on an as-needed basis; for example, as required to evaluate work-related illness or exposures to infectious diseases.

• Do not perform routine cultures on personnel, such as cultures of the nose, throat, or stool, as part of the placement evaluation.

• Conduct routine screening for tuberculosis by using the intradermal (Mantoux), intermediate strength (5 TU) PPD test.

• Conduct routine serologic screening for some vaccine-preventable diseases, such as hepatitis B, measles, mumps, rubella, or varicella, if deemed to be cost-effective to the hospital and beneficial to the health-care personnel.

Job-related illnesses and exposures

Keep a record on health care personnel including information obtained during the placement evaluation, immunization records, results of tests obtained and any screening or control programs, and reports of work-related illnesses or exposures.

• Establish a readily available mechanism for personnel to obtain advice about illnesses they may acquire from or transmit to patients.

• Evaluate job-related and community-acquired illnesses or important exposures and post-exposure prophylaxis, when indicated.

• Develop written protocols for handling job-related and community-acquired infectious diseases or important exposures. Record the occurrences of job-related infectious diseases or important exposures in the person’s record and, when applicable, notify the appropriate member of the infection control committee and personnel health service.

• Establish and keep an updated record for each worker, and maintain the confidentiality of the person while ensuring that the person receives appropriate therapeutic or prophylactic management for illnesses caused by or following exposures to transmissible infections. Ensure that individual records for volunteers, trainees, contractual personnel, and "prehospital" personnel are similarly kept and maintained.

Reference

1. Centers for Disease Control and Prevention. Hospital Infection Control Practices Advisory Committee. Guideline for Infection Control in Health Care Personnel [Draft version; December 9, 1996].