3. Assessment and Reduction of Risks for Infection among Healthcare Personnel Populations

Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (2019)

Recommendations

See section 1. Leadership and Management for additional related recommendations.

For healthcare organization leaders and administrators

For occupational health services leaders and staff

Background

HCP are at risk of infectious exposures in the workplace that vary depending on their job duties and other factors.[1,2] Assessments can be conducted to identify actual or potential infection risks for populations of HCP and to inform measures that reduce those risks. Risk assessments can also yield data used for performance measurement, facility accreditation, service improvements, regulatory compliance, and other quality assurance activities (see section 1. Leadership and Management). Risk assessments may be prompted by the desire to create a safer workplace; federal, state, or local requirements; and by incidents, such as reports of exposures or illnesses among HCP, infectious disease outbreaks, and device and equipment failures resulting in HCP exposures or injuries.

Approaches to risk assessment and reduction

Depending on HCO management structure and type of risk, OHS may lead some risk assessment and reduction activities or collaborate with other HCO departments, such as IPC services, that lead these efforts (see section 2. Communication and Collaboration). Such activities could include improving access to services by providing resources at off-site job locations during work hours, or working with supply management counterparts to ensure HCP access to correct PPE. Box 3. Examples of Hazard Identification, Risk Assessment, and Risk Reduction Activities lists examples of risk assessments and reduction strategies that might commonly involve OHS.

Controlling exposures to occupational infections is a fundamental method of protecting HCP. Traditionally, a hierarchy of controls (Figure 1. Hierarchy of Controls) has been used as a means of determining how to implement feasible and effective control solutions.[3] The hierarchy ranks controls according to their reliability and effectiveness, leading with “Elimination” of a potential hazard, whereby it is completely removed, and ending with “PPE” that relies on correct, consistent use.

Figure 1. Hierarchy of Controls

Source: Centers for Disease Control and Prevention

Selected requirements related to the assessment and reduction of occupational infection risks

Occupational IPC assessment activities are supported or required by federal, state, or local regulations, payers, and accreditation agencies. Requirements include, but are not limited to:

• OSHA requires HCO to maintain logs of work-related injuries and illnesses meeting certain criteria, including infectious diseases exposures.[4,5] Review of these logs can identify trends in occupational exposures or acquired infectious diseases among HCP that warrant mitigation.
• OSHA requires employers to conduct workplace evaluations to assess implementation of an Exposure Control plan for all affected employees.[5,6]
• OSHA requires employers to evaluate respiratory hazards in the workplace, and to implement a respiratory protection program, if needed.[7]
• CMS requires that some HCOs report HCP influenza immunization coverage to the National Healthcare Safety Network (NHSN) as a CoP.[8]
• The Joint Commission standards require establishing an influenza vaccination program for staff, setting incremental vaccination goals to increase coverage, and reporting HCP influenza immunization rates to key stakeholders.[9]

OSHA further supports risk assessment and reduction activities with online information and tools, including a job hazard analysis booklet and “eTools” about workplace health and safety topics.[10,11] OSHA also offers some employers free consultation on evaluating workplace hazards and control methods without risk of citations or fines, provided that the employer corrects identified hazards.[12]

References

1. The National Surveillance System for Healthcare Workers (NaSH) Summary report for blood and body fluid exposure data collected from participating healthcare facilities, (June 1995 through December 2007) pdf icon[PDF – 27 pages]. Centers for Disease Control and Prevention. Published June 2011. Accessed August 20, 2019.
2. Wise ME, De Perio M, Halpin J, et al. Transmission of pandemic (H1N1) 2009 influenza to healthcare personnel in the United States. Clin Infect Dis. 2011 Jan 1;52 Suppl 1:S198-204.
3. Hierarchy of Controls. National Institute for Occupational Safety and Health. Accessed August 20, 2019.
4. OSHA Forms for Recording Work-Related Injuries and Illnesses[PDF – 12 pages]pdf iconexternal icon. Occupational Safety and Health Administration. Accessed August 20, 2019.
5. Standard 1910.1030 – Toxic and Hazardous Substances, Bloodborne Pathogensexternal icon. Occupational Safety and Health Administration. Revised April 3, 2012. Accessed August 20, 2019.
6. Directives: Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogensexternal icon. Occupational Safety and Health Administration. Accessed August 20, 2019.
7. Standard 1910.134 – Respiratory Protectionexternal icon. Occupational Safety and Health Administration. Revised June 8, 2011. Accessed August 20, 2019.
8. National Healthcare Safety Network (NHSN). CMS Requirements. Centers for Disease Control and Prevention. Revised August 9, 2019. Accessed August 20, 2019.
9. Standard IC.02.04.01 Influenza Vaccination for Licensed Independent Practitioners and Staff (HAP, CAH, LTC)external icon. The Joint Commission. Published December 2, 2011. Accessed August 20, 2019.
10. eTools, eMatrix, Expert Advisors and v-Toolsexternal icon. Occupational Safety and Health Administration. Accessed August 20, 2019.
11. Hazard Identification Training Toolexternal icon. Occupational Safety and Health Administration. Accessed August 20, 2019.
12. OSHA Fact Sheet: The OSHA Consultation Program[PDF – 2 pages]pdf iconexternal icon. Occupational Safety and Health Administration. Accessed August 20, 2019.

Box 3. Examples of Hazard Identification, Risk Assessment, and Risk Reduction Activities in which Occupational Health Services Might Participate

Footnote

1. See Figure 1. Hierarchy of Controls.