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Element VI: The prevention and management of infectious or communicable disease in healthcare workers.
Because of their contact with patients or infective material from patients, many healthcare workers (e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, and administrative staff, etc.) and healthcare organizations utilize multiple interventions to prevent and/or manage infections in healthcare workers (CDC, 1997).
Initially, new employees are generally required to have a pre-employment physical; presumably any infection can be identified at that time and treatment initiated or management strategies employed prior to contact with patients or coworkers. Because healthcare workers are at risk for exposure to and possible transmission of vaccine-preventable diseases, maintenance of immunity is an essential part of prevention and infection control programs for healthcare workers. Optimal use of immunizing agents safeguards the health of workers and protects patients from becoming infected through exposure to infected workers (CDC, 1997).
In addition to pre-employment screening or testing for infection and illness, vaccinations for vaccine-preventable illnesses, maintenance of good health, and the utilization of engineering and work practice controls are all methods to minimize the risk of acquiring or transmitting an infectious disease.
The estimated number of occupational HBV
infections among U.S. healthcare workers has decreased significantly
over the last 20 years. Data from the National Notifiable
Diseases Surveillance System (NNDSS) indicated a 96% decline
in HBV infections among healthcare workers over a 17-year
period-from nearly 11,000 cases in 1983 to fewer than 400
in 1999. This reduction is largely due to the adoption of
universal precautions in the mid-1980s by healthcare facilities
and the 1992 OSHA Bloodborne Pathogen Standard (29 CFR 1910.1030),
which required employers to offer HBV vaccinations to exposed
workers (NIOSH, 2004).
ACIP has developed the following adult immunization schedule for October 2005 - November 2006.
View the Adult Immunization Schedule.
During the time frame from 1981 through December 2002, 57 cases of documented occupational transmission of HIV to healthcare workers occurred. In that same time frame, 139 cases of occupational transmission of HIV to healthcare workers were possible (NIOSH, 2004).
Most documented cases of occupational HIV transmission occurred among nurses (24 cases or 42.1%) and laboratory workers (19 cases or 33.3%). These cases were reported to the HIV/AIDS Reporting System. Among the documented cases of HIV following occupational exposure, 84% resulted from percutaneous exposure (NIOSH, 2004).
Exposure prevention remains the primary strategy for reducing occupational bloodborne pathogen infections. Despite the various controls in place to prevent occupational transmission, sometimes healthcare workers do come into contact with infectious agents (CDC, 2001).
Healthcare facilities will have policies and procedures for the prevention of occupational exposure in place as part of their administrative controls related to infection control, however, these facilities will also have policies and procedures in place regarding reporting, evaluation, counseling, treatment and follow-up of occupational exposure (CDC, 2001).
Healthcare workers must be educated concerning the risk of and prevention for bloodborne pathogens, including the need to be vaccinated against HBV. Employers are required to establish exposure control plans that include post-exposure followup for employees and to comply with the incident reporting requirements of the 1992 OSHA Bloodborne Pathogens Standard. Access to clinicians who can provide post-exposure care should be available during all working hours, including nights and weekends. Hepatitis B immunoglobulin (HBIG), HBV vaccine and antiretroviral agents for post-exposure prophylaxis should be available in a timely manner, either by providing access onsite or by developing linkages with providers or facilities that can provide such service off-site. Those individuals who are responsible to provide post-exposure management must be knowledgeable about the evaluation and treatment protocols and the facility's plans for accessing post-exposure medications (CDC, 2001).
Healthcare workers must be informed to report occupational exposures immediately after they occur because prophylactic treatment is most effective when administered as soon after the exposure as possible (CDC, 2001).
In the event that wounds or skin sites have been in contact with blood or body fluids, the sites must immediately be washed with soap and water; mucous membranes should be flushed with water. No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of transmission; however, the use of antiseptics is not contraindicated (CDC, 2001).
In the event of an occupational exposure, the exposure and post-exposure management should be recorded in the exposed person's medical record. A facility may have a specific form for such an exposure. Employers must follow all federal and state requirements for recording and reporting occupational injuries and exposures (CDC, 2001).
The specific details about post-exposure management and treatment can be found in the Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV (2001) available at
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf.
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