Infection Control

Joey Sweeney, PharmD, BCPS

Preventing infectious disease transmission among health care workers and patients is a critical component of safe health care delivery in all settings. CDC recently updated four sections of its 1998 guideline for infection control in health care personnel: Infection Control Objectives for a Personnel Health Service, Elements of a Personnel Health Service for Infection Control, Emergency-Response Personnel, and the Americans with Disabilities Act. CDC noted that recommendations in other sections of the 1998 guideline are current.

The updated recommendations, aimed at the leaders and staff of occupational health services (OHS) departments (commonly referred to as “employee health departments”) as well as leaders of health care organizations, are intended to facilitate the provision of occupational infection control services to health care workers. The recommendations are based on a systematic review of literature on infection prevention and control studies and systematic reviews published from January 2004 to December 2015.

The updated recommendations target eight elements of infection prevention and control tasks that fall under health systems’ OHS departments. The document does not address noninfectious elements of occupational health, such as slips, trips, and falls; patient handling injuries; chemical exposures; health care professional (HCP) burnout; and workplace violence.

Leadership and management

CDC recommends creating and nurturing an organizational culture that places a high importance on infection prevention and control.  Dedicating at least one person to the OHS with relevant authority and resources is paramount to ensuring a consistently high level of service. This department should also be tasked with ensuring compliance with infection prevention and control regulations and should be focused on goals that involve improvement in measurable areas related to infection prevention and control.

Communication and collaboration

Leadership across all levels of the health care organization should be supportive of the OHS department and collaborate with initiatives the department undertakes. Positive cultural change rarely successfully takes hold without the deep involvement of leadership within any organization.  Senior leadership should specifically be engaged to champion activities related to infection prevention and control.

Assessing and reducing risks for infection among HCP populations

Controlling exposures to occupational infections is a fundamental method of protecting health care workers. Traditionally, a hierarchy of controls (see figure) has been used to determine how to implement feasible and effective control solutions. The hierarchy ranks controls according to their reliability and effectiveness, leading with elimination of a potential hazard and ending with consistent use of personal protective equipment.

Leadership of the organization should also meet regularly with the OHS department to evaluate risk assessments related to infection prevention and control, and assist when they are able to reduce hazards identified by the OHS department. It is incumbent upon the OHS department to surface relevant priorities to leadership. The OHS department’s main objective is to protect health care personnel, and they must ensure that their risk reduction plans are effective at reducing the risk of these frontline workers.

Medical evaluations

Medical evaluations should be incorporated into policies and procedures at the prehiring level, as well as periodically after hiring. Immunizations and immunity documentation are pillars of the OHS department’s strategy to minimize vaccine-preventable diseases among the workforce and the patients it serves.

In addition to disease prevention, management of new conditions such as pregnancy or skin lesions are important to consider in the greater context of medically supporting health care workers.

Education and training on occupational infection prevention and control

All the planning, preparation, goals, and metrics in the world will do nothing to reduce infection in workers if they are not educated on the proper way to operate within their work environment.  Therefore, education and training are critical to a successful infection prevention and control strategy in an organization. Ensuring the OHS department has adequate staff and funding to carry out appropriate educational and training activities is the only way to actually reduce infections.

Topics for such development include hand hygiene, sharps handling, immunization requirements, reporting illness/injury, basic didactic education on disease transmission, and how to contact OHS.

Immunization programs

Adhering to CDC’s Advisory Committee on Immunization Practices recommendations for worker immunization requirements is a baseline goal. Setting goals for the OHS department to achieve certain rates is one way to incentivize increased immunization rates.

Managing potentially infectious exposures and illnesses

Establishing a nonpunitive mechanism for workers to report exposure is the best way to ensure safe practice development continues to improve. Ensure that these reporting mechanisms are in place around the clock so that all shifts of workers are adequately served by the OHS department. If an exposure occurs, it is important to take appropriate prophylaxis and treatment measures. Last, CDC recommends a thoughtful examination of how work restrictions are imposed and subsequently cleared.

Managing HCP health records

As part of the quality improvement process,  CDC recommends that the electronic health record used to confidentially maintain work-related records should also be capable of aggregating and de-identifying information that can be used for surveillance and other initiatives. Workers should be able to receive their records from this system within 15 days of requesting access.