Exploring CDC Guideline Updates for Infection Control in Healthcare Personnel

The US Centers for Disease Control and Prevention (CDC) recently released an update to the 1998 guidelines for occupational health infection prevention. This new edition provides guidance in many areas of occupational health, including leadership and management, communication, assessment, risk reduction, education, and immunizations. The intent of these guidelines is to provide recommendations to leadership and staff of occupational health (OH) programs in the services they provide that are related to infection prevention (IP) activities that reduce the risk of disease transmission among health care providers (HCP) and patients. As many infection preventionists may hold dual roles in occupational health, or are considered, at minimum, subject matter experts and strong collaborators with occupational health programs, these updates will be a valuable resource for infection preventionists. 

The leadership structure of OH programs can vary depending on the healthcare settings. It is imperative that the staff assigned to these roles understand the responsibilities associated with providing the OH program. If staff are in multi-purpose roles, the resources may be focused on meeting regulatory requirements and the other aspects of the program may not receive as much attention. Organizations can help support OH programs by providing dedicated staff and encouraging certification. 

One of the main areas under this section is performance measurement and quality improvement. In order to validate the effectiveness of the OH program, it is key to be able to assess data regarding specific outcomes such as HCP exposures, HCP follow up for testing, HCP conversions after exposure, tuberculosis screening and fit testing completion, vaccine compliance, and many others. Unfortunately, OH programs can be under-resourced in the areas of data analytics, and in order to be able to extract this information in a rapid and accurate method can be a challenge. By investing in the technological infrastructure around OH, time spent on manual data collection can be geared toward more clinical and quality improvement efforts. 

Emergency preparedness is another area where OH capacity can be strengthened. Overall healthcare preparedness for a biohazardous event, such as pandemic flu or emerging infectious diseases, is lacking across the nation. Infection preventionists are the subject matter experts for those situations, however OH programs will be integral for the HCP follow-up and support if such events were to occur. Occupational health programs should be included in any organization’s plans and exercises involving biohazardous events. 

Communication and collaboration within OH programs and across the organization can improve the safety of HCP and the effectiveness of the program. OH staff need to be at the table for decisions made with ordering of new supplies such as needles, sharps, disposal containers, and personal protective equipment. Also, communication can be a challenge when the OH program staff are dispersed across an organization. Infection prevention often is a liaison between OH programs and clinical staff and must reinforce the need for effective communication across the programs. 

Regular risk assessments for OH programs are essential to ensure that the needs of the HCP are being met and can guide the focus areas for improvement for the program. If OH does not have the capacity for maintaining its own regular risk assessments, collaboration with IP can ensure that at least annually the OH aspects associated with IP can be included in the annual IP risk assessment that is performed. Risk assessments should be done any time there is a change in services provided or in the work environment that may change the way that care is being provided by the HCPs. There are many templates available for risk assessments, and not all have to be a large undertaking, but at minimum there should be documentation that the OH program has reviewed this new service or change, has evaluated whether there is increased risk for transmission of infection and, if necessary, has outlined steps that can be taken to mitigate that risk. 

Medical evaluations are the largest component of clinical duties for OH programs. Of particular concern for the IP are the vaccination and immunity verification pre-employment, assessment for respirator testing, TB screening, post-exposure monitoring and testing, and other routine or special cause evaluations. Pre-employment screening is key to ensuring staff can be safely placed into the workforce. However, due to pressures to place staff quickly in order to provide continuity of services, it may be difficult to complete screenings for all new hires in the most optimal method. In this case, IP and OH need to collaborate to reinforce the importance of a thorough pre-employment screening, as well as meet with human resources in the onboarding process to advocate for the appropriate time considerations for this step. 

Education on OH policies and procedures is done for HCPs upon new hire, in annual refresher trainings and as needed based on situation. Several topics are required education based on federal regulations, including blood borne pathogen training, respiratory protection standards, and PPE standards. Often OH and IP programs collaborate on this training. As with any staff education, it is important that the health literacy of the audience be assessed, and the information be presented in a way that is understandable and applicable to their work functions. 

Immunization programs have become increasingly important in the role of ensuring staff and patient safety. With the reemergence of vaccine-preventable diseases (VPD) and the requirements many organizations have for annual flu vaccination, these programs can be resource intensive. The role of IP in these programs is to provide guidance on the types of vaccination that should be required for HCPs based on job risks and work duties. Also, IP can help with the logistical planning of administration of annual flu vaccine campaigns. Along with the administration of the vaccines, equally important is the record management of staff vaccine history. Again, without a robust IT infrastructure, many OH programs rely on paper and manual methods for tracking vaccination status. This can be cumbersome and unreliable, especially in the case of an exposure to a VPD or for reporting purposes. IP also can assist with developing strategies to increase HCP uptake of vaccines. If there is a challenge in getting HCP to receive vaccines, an assessment can be performed to determine what barriers staff perceive with complying and efforts can be targeted to addressing those barriers. 

There are many challenges with the prompt and effective management of potential communicable disease exposures: staff may not report an exposure until many days after it has occurred; tracking down all staff who may have come in contact with a potential source and then making sure those staff are contacted and follow through with OH evaluations; making sure policies and procedures are in place to handle exposures on off hours when OH is not available; and enforcing workplace restrictions or sick leave for HCP who may be ill. Often the IP program is the first to alert OH that an exposure has occurred, and then both teams must work closely together to investigate and prevent further exposures. Hospital leadership is needed to support when staff are required to take work restrictions or to have staff come to OH for evaluation after an exposure has occurred. 

Occupational health and infection prevention programs work integrally to ensure the safety of staff, providers, and patients. Having a strong OH program will only enhance the capabilities of the IP program to be successful. Infection preventionists should understand the role of the OH program and all the ways it touches IP practices. The updated guidance from CDC provides an opportunity for OH and IP to review the recommendations, perform a joint gap assessment of the current state of the OH program, and develop strategies to implement, enhance, and strengthen the infection prevention services of the OH program.