CDC: 1997 Guidelines For Infection Control In Health Care Personnel

CDC: 1997 Guidelines For Infection Control In Health Care Personnel

Legal Eagle Eye Newsletter for the Nursing Profession

October 1997

Quick Summary: The CDC has published its Draft Guidelines for Infection Control in Health Care Personnel, 1997.

We can excerpt in this space only some of the CDC’s general recommendations. We have reprinted all of the CDC’s specific recommendations for bloodborne pathogens. All of these are Category IA or IB, meaning "strongly recommended for all hospitals," according to the CDC. FEDERAL REGISTER, September 8, 1997 Pages 47275 - 47327.

The Centers for Disease Control and Prevention has put out "Draft Guidelines for Infection Control in Health Care Personnel, 1997."

Having made the document public on September 8, 1997 in the Federal Register, the CDC has asked for public review and comment, until mid-October, 1997.

The guidelines are in two parts. The first part is an overview of infection control issues; the second sets out the CDC’s recommendations. Due to the length of the full document, we have excerpted and reprinted only some of the CDC’s general recommendations, and all of the CDC’s specific recommendations for bloodborne pathogens. These general and specific recommendations, according to the CDC, are strongly recommended for all hospitals.

Note that we have obtained this material verbatim from the U.S. Government Superintendent of Documents web site (http://www.access.gpo.gov/su_docs). Thus the material is not under copyright, and can be copied from U.S. Government sources and/or from this newsletter for any use by any interested party.

The full text of the CDC’s new guidelines can be obtained on the Internet as indicated above. The Federal Register (Vol. 62, No. 173 pages 47275-47327) is on the reference shelves of many public libraries, academic libraries and law libraries, and can be purchased from the U.S. Government Printing Office, Order and Information Desk, Washington, DC 20402-9329 or by calling (202) 512-1800.

Part II. Recommendations for Prevention of Infections in Health Care Personnel

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2. Placement evaluation

a. Before personnel begin duty or are given a new work assignment, obtain their health inventories. Include in the inventories the following:

(1) immunization status or history of vaccine preventable diseases (e.g., chickenpox, measles, mumps, rubella, hepatitis B);

(2) history of any conditions that may predispose personnel to acquiring or transmitting infectious diseases (e.g., immunosuppressive condition or therapy, tuberculosis, dermatologic conditions, chronic draining infections or open wounds, or chronic infections).

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

c. 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.

d. Do not perform routine cultures on personnel (e.g., cultures of the nose, throat, or stool) as part of the placement evaluation.

e. Conduct routine screening for tuberculosis by using the intradermal (Mantoux), intermediate strength (5 TU) PPD test on personnel who have potential for exposure to TB.

f. 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.

3. Personnel Health and Safety Education a. Include the infection control aspects of personnel health and the proper use of the personnel health service in the initial job orientation and ongoing in-service education of personnel.

(1) Ensure that the following topics are included in the initial training on infection control: (a) handwashing; (b) modes of transmission of infection and importance of complying with standard and isolation precautions; (c) importance of reporting certain illnesses or conditions (whether work related or acquired outside the hospital), such as generalized rash or skin lesions that are vesicular, pustular, or weeping; jaundice; illnesses that do not resolve within a designated period of time (e.g., a cough that persists for 2 weeks, gastrointestinal illness, or febrile illness with fever of 103^o F lasting more than 2 days) and hospitalizations resulting from febrile or other contagious diseases; (d) tuberculosis control; (e) importance of complying with Standard Precautions and reporting exposure to blood and body fluids to prevent transmission of bloodborne pathogens; (g) importance of cooperating with infection control personnel during outbreak investigations; and (h) importance of personnel screening and immunization programs.

(2) Ensure that all personnel know that if they have medical conditions (e.g., immunosuppression) or receive medical treatment that renders them more susceptible to or more likely to transmit infections, they can follow recommendations to greatly reduce their risk for transmitting or acquiring infections, e.g., request for work reassignment.

b. Make specific written policies and procedures for control of infections in health care personnel readily available.

c. Provide personnel, annually, and whenever the need arises, with in-service training and education on infection control that are appropriate and specific for their work assignments so that personnel can maintain accurate and up-to-date knowledge about the essential elements of infection control.

d. Provide educational information appropriate, in content and vocabulary, to the educational level, literacy, and language of the employee.

4. Job-Related Illnesses and Exposures

a. Maintain a record on health care personnel that includes information obtained during the medical evaluation, immunization records, results of tests obtained in any screening or control programs, and reports of work-related illnesses or exposures in accordance with state and federal regulatory requirements.

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

c. Evaluate job-related and community-acquired illnesses or important exposures and postexposure prophylaxis, when indicated.

d. 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 appropriate infection control personnel and members of the personnel health service.

5. Record-Keeping, Data Management, and Confidentiality

a. Establish and keep an updated record for all personnel and maintain the confidentiality of their records while ensuring that they receive 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 personnel who provide care outside of hospitals are similarly kept and maintained.

b. Ensure that when data on personnel health are made public, the individual's confidentiality is maintained, for example, by releasing only aggregate numbers.

c. Maintain a personnel data base, preferably computerized, that allows tracking of personnel immunizations, screening tests, and assessment of trends of infections and diseases in personnel. Copies of these records are to be available to the individual.

d. Periodically review and assess data gathered on personnel health (e.g., rates of PPD-test conversion) to determine the need for action.

e. Ensure that all federal, state, local, and community standards on medical record keeping and confidentiality are met.

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G. Prevention of Nosocomial Transmission of Selected Infections

1. Bloodborne Pathogens, General Recommendation

a. Ensure that health care personnel are familiar with precautions to prevent occupational transmission of bloodborne pathogens.

b. Follow state and federal guidelines and strategies for determining the need for work restrictions for health care personnel infected with bloodborne pathogens.

a. Hepatitis B. (1) Administer hepatitis B vaccine to personnel who perform tasks involving routine and inadvertent (e.g., as with housekeepers) contact with blood, other body fluids (including blood-contaminated fluids), and sharp medical instruments or other sharp objects.

(2) Before vaccinating personnel, do not routinely perform serologic screening for hepatitis B vaccine unless the health care organization considers screening cost-effective or the potential vaccinee requests it.

(3) Conduct post vaccination screening for immunity to hepatitis B within 1 to 2 months after the administration of the third vaccine dose to personnel who perform tasks involving contact with blood, other body fluids (including blood-contaminated fluids), and sharp medical instruments or other sharp objects.

(4) Revaccinate persons not found to have an antibody response after the initial hepatitis B vaccine series with a second three dose vaccine series. If persons still do not respond after revaccination, refer them for evaluation for lack of response, (e.g.,possible chronic HBV infection).

(5) Test staff in chronic dialysis centers who do not respond to the hepatitis B vaccine for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs) semi-annually.

(6) Use both passive immunization with hepatitis B immune globulin and active immunization with hepatitis B vaccine for postexposure prophylaxis in susceptible personnel who have had a needlestick, percutaneous, or mucous membrane exposure to blood known or suspected to be at high risk for being HBsAg positive.

(7) Follow current recommendations for postexposure prophylaxis following percutaneous or mucous membrane exposure to blood and body fluids that is known or suspected to be at high risk for being HBsAg-positive.

b. Hepatitis C. (1) Do not administer immune globulin (IG) to personnel who have exposure to blood or body fluids positive for antibody to hepatitis C virus.

(2) Consider implementing policies for postexposure follow-up for health care personnel who have had a percutaneous or mucosal exposure to blood containing antibody to hepatitis C virus at baseline and 6 months.

c. Human Immunodeficiency Virus (HIV). Follow current recommendations for postexposure prophylaxis following percutaneous or mucocutaneous exposure to suspected or known HIV-infected blood or body fluids containing blood. FEDERAL REGISTER, September 8, 1997 Pages 47275 - 47327.