Occupational Health: Joining Forces With Infection Prevention

By Kelly M. Pyrek

Two cornerstones of a culture of safety in the healthcare environment are occupational health (OH) services and infection prevention and control (IPC), and without direct communication and collaboration, healthcare personnel and patient safety can be jeopardized. 

When One Functions as Two

In some hospitals, OH services and IPC are handled by one leader tasked with leveraging the synergies of both disciplines into a comprehensive healthcare worker and patient safety program. Personnel can be cross-trained in core activities such as surveillance, as well as receive education and instruction around the importance of personal protec-tive equipment (PPE), vaccination, sharps safety and handwashing, among other interventions.

While both disciplines emphasize a culture of safety within the healthcare institution, there are nuances between the two that should be explored to better understand each department's clinical and operational imperatives.  

For example, individuals working in OH might not be up to speed on isolation precautions for patients and the implica-tions of non-compliance. 

"With emerging infectious diseases and new resistant strains occurring it would be helpful for IPC to review these with OH to discuss how they isolation is handled and if any follow-up is needed for employees," says Bobbi Jo Hurst, MBA, BSN, RN, COHN-S, manager of employee health and safety at Penn Medicine/Lancaster General Health and communi-ty liaison for the Association of Occupational Health Professionals in Healthcare (AOHP). "It might be nice when some-thing new comes out that IPC is learning about that they send a fact sheet to OH."

Conversely, Hurst notes, " I do feel that IPC should be aware that OH staff members are one the of their great re-sources for protecting the patients through the protected employees.  That starts with an awareness of what each of the departments does and how they support each other through this.  In addition, they certainly need to know the requirements that OH has for staff regarding vaccines as well as the follow-up that OH does for communicable illness-es." 

And if just one individual truly is wearing both OH and IPC hats, it is critical for this time-strapped leader to secure the resources, staff and budget they need to attend to both disciplines adequately.

"Many times, resources are a problem when it comes to OH," Hurst confirms.  "This has been a discussion held at many meetings. IPC has the standard of staffing that is appropriate. OH staff job duties vary so much that it is difficult to even know what an adequate staff pattern should be unless consultants have been hired to accurately evaluate the staffing needs.  Then with this said, it does not translate to an employee/staff ratio that can be shared with all OH departments. The best answer to this is that it must be individualized, and some type of study conducted to ensure adequate staffing is in place." 

When Two Become One

And sometimes, it's a dynamic duo that addresses both disciplines as a combined force. Lisa Barone, BSN, RN, CIC, di-rector of infection control, and Theresa Schrantz, LPN, CIC, employee health coordinator -- both at Brooks-TLC Hospital System -- have teamed up to create a combined approach that works particularly well for their facility.

"The health and safety of our personnel is very important to us, and we work together to make sure it has a positive impact on our patients," says Barone.

"In our perspective you need to embrace each other’s knowledge and work together because so much of what we do is connected and affects each other," says Schrantz. "To our readers who have any doubt consider this… if IPC focuses on patients, and OH focuses on employees, and employees take care of patients, and patients rely on employees for safe care, how do remove any part of this equation?"

Collaboration is clearly key.  

"It is really important that IP and OH communicate and work as a team," Hurst emphasizes.  "This allows a free flow of communication about potential communicable conditions that have occurred in the healthcare facilities and the treat-ment and care of the individuals.  There are times that employees may approach Employee Health with concerns about patients that we are unaware of. OH must also inform IPC of any concerns they have regarding illnesses that could be communicable to patients.  Most importantly, there must be a mutual respect for each department’s role in keeping healthcare workers and patients safe."  

Barone explains that having a plan that is understood by both departments is essential to a high-functioning safety culture. "It is important that OH knows and understands the Infection Control Plan that is developed at the beginning of the year to identify and minimize risk to both patients and healthcare workers," she says. ".For example, if hand hygiene compliance is both a risk and goal, OH should be aware because the more employees clean their hands, the higher risk of dermatitis, and other skin issues. During Influenza season, OH should be aware of the number of patients admitted with flu and flu-like symptoms for employee illness tracking." 

Schrantz advises that IPC "be aware of employee illness surveillance so that if there are increased number of patients with similar illness, or potentially a patient causing employee illness, I would be aware. Also, IPC should know the per-centage of employee flu vaccination to know how it may affect the spread of disease." 

Barone adds, "In our facility, we have found that sharing an office has proven to be effective with communication, reaching goals, and showing unity to the staff.  If this isn’t possible and departments are separate, communication is key.  Discuss what the goals are for the year and how they overlap.  Is there education for staff that can be combined? When will flu vaccinations start?  Share monthly dashboards with goals and actions. In our situation we learned enough about each other’s positions to be able to 'cover' for each other.  Theresa even became certified in infection control (CIC). This helps in understanding each role and keeps things consistent and up to date even if one person is away. "

"Wearing both hats can be both a blessing and a curse," Barone continues. "When you do it all, you can do it any way you want to.  However, when you do it all, you do it all!  The most important thing in my mind is to get the support of administration. Make them aware of the requirements and regulations, the infection control plan, recommended staffing for infection prevention departments, and importance of certification."

"Form a strong relationship with nursing supervisors so they will help with education and vaccination, etc., especially on the “of-shifts," Schrantz suggests. "Utilize vendors for education of new products. Be the expert and a consultant, empowering the department managers to enforce and monitor employee activity. Realize that infection prevention and employee wellness must be a team effort."

Shared Priorities

As we will explore elsewhere in this issue, healthcare personnel vaccination is one occupational health-related issue that has profound implications for infection prevention and control.

"Vaccination and the use of PPE is a top priority in reducing the spread of any communicable illness and has prevented the spread of diseases so many times," Hurst says. "I feel we have come a long way from years ago, but we still have some work to do.  Eye protection continues to be a concern to me, as staff members do not know when they will be coughed on or have drainage/blood splash and hit them in the eyes." 

"Vaccination is a high priority in our facility, so much that we take a mobile cart to the departments for flu shots so that those who are too busy to leave their area to receive it," reports Barone.  "We commonly encounter patients from the Amish community who are unvaccinated for example, and so we highly encourage all staff to take advantage of the vaccines we offer free of charge. Both OH and IPC understand the importance of protecting the patients and employees.  We even offer a free flu vaccination clinic for our employees’ families. Pre-employment vaccination status is veri-fied prior to start of work as well. We currently have higher standards for PPE than the CDC recommends. I believe that making it easy increases compliance. Staff members must wear gown and gloves in every isolation room, and a mask when indicated. It takes away the guess-work, its easily understood by staff and visitors, and makes for easy auditing." 
 
Ultimately, supporting the health and safety of healthcare personnel supports the goal of patient safety, so the two disciplines remain inseparable.

Hurst emphasizes the value of this connection: "I believe that without safe staff you cannot provide safe patient care. Many times, it is mentioned, but many institutions have not place a priority on the connection when looking at the patient safety issues.  When staff are safer they will become more engaged, they will not be spreading illness to patients because they will wear PPE and get immunized, all this adds to fewer errors and spreading of disease.  I also believe if we look at safe patient handling, falls will decrease."