Infrastructure and Routine Practices
Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (2019)
This document is an update of 4 sections of Part I of the Guideline for infection control in health care personnel, 1998 and their corresponding recommendations in Part II:
- C. Infection Control Objectives for a Personnel Health Service
- D. Elements of a Personnel Health Service for Infection Control
- H. Emergency-Response Personnel
- J. The Americans With Disabilities Act
- Leadership and Management
- Communication and Collaboration
- Assessment and Reduction of Risks for Infection among Healthcare Personnel Populations
- Medical Evaluations
- Occupational Infection Prevention and Control: Education and Training
- Immunization Programs
- Management of Potentially Infectious Exposures and Illnesses
- Management of Healthcare Personnel Health Records
Recommendations
1. Leadership and Management
For healthcare organization leaders and administrators
Number
Recommendation
Number
1.a.
Recommendation
Invest in an organizational culture that prioritizes safety and occupational infection prevention and control.
Number
1.b.
Recommendation
Regularly review organizational information about occupational infectious risks, exposures, and illnesses with occupational health services.
Number
1.c.
Recommendation
Dedicate one or more persons with appropriate authority and training to lead occupational infection prevention and control services.
Number
1.d.
Recommendation
Provide sufficient resources (e.g., expertise, funding, staff, supplies, information technology) to implement elements of occupational infection prevention and control:
- Leadership and management,
- Communication and collaboration,
- Assessment and reduction of risks for infection among healthcare personnel populations,
- Medical evaluations,
- Occupational infection prevention and control education and training,
- Immunization programs,
- Management of potentially infectious exposures and illnesses, and
- Management of healthcare personnel health records.
Number
1.e.
Recommendation
Oversee, and include occupational health services leaders in, performance measurement and continuous quality improvement activities for occupational infection prevention and control services.
For occupational health services leaders and staff
Number
Recommendation
Number
1.f.
Recommendation
Promote an organizational culture with a consistent focus on safety and occupational infection prevention and control.
Number
1.g.
Recommendation
Develop occupational infection prevention and control services that are tailored to the needs of healthcare personnel and the environment in which they work.
Number
1.h.
Recommendation
Develop, review, and update when necessary, written policies and procedures that adhere to federal, state, and local requirements for elements of occupational infection prevention and control services:
- Leadership and management,
- Communication and collaboration,
- Assessment and reduction of risks for infection among healthcare personnel populations,
- Medical evaluations,
- Occupational infection prevention and control education and training,
- Immunization programs,
- Management of potentially infectious exposures and illnesses, and
- Management of healthcare personnel health records.
Number
1.i.
Recommendation
Inform all healthcare personnel and relevant healthcare organization departments about occupational infection prevention and control policies and procedures.
Number
1.j.
Recommendation
Collaborate with appropriate healthcare organization departments and individuals to:
Number
1.j.1.
Recommendation
Achieve compliance with regulations related to occupational infection prevention and control.
Number
1.j.2.
Recommendation
Develop infectious disease emergency and outbreak management plans.
Number
1.j.3.
Recommendation
Develop and monitor performance measures for occupational infection prevention and control services that include the proportion of healthcare personnel with documented evidence of immunity and the proportion of healthcare personnel vaccinated, as appropriate, for each vaccine-preventable disease recommended for healthcare personnel by the Advisory Committee on Immunization Practices (ACIP).
Number
1.j.4.
Recommendation
Set and meet quality improvement goals for occupational infection prevention and control services and report performance measures and areas for improvement to management.
Number
1.j.5.
Recommendation
Periodically assess the effectiveness of occupational infection prevention and control services.
2. Communication and Collaboration
For healthcare organization leaders and administrators
Number
Recommendation
Number
2.a.
Recommendation
Establish organizational goals, policies and procedures, infrastructure, and interventions that foster communication and collaboration about occupational infection prevention and control.
For occupational health services leaders and staff
Number
Recommendation
Number
2.b.
Recommendation
Engage senior leaders, administrators, leaders of other programs that share activities related to occupational infection prevention and control, and healthcare personnel to foster collaborative decision-making.
Number
2.c.
Recommendation
Participate in the development of policies, procedures, and interventions that affect occupational infection prevention and control.
3. Assessment and Reduction of Risks for Infection among Healthcare Personnel Populations
For healthcare organization leaders and administrators
Number
Recommendation
Number
3.a.
Recommendation
Regularly meet with occupational health services leaders to review results of risk assessments related to occupational infection prevention and control, set performance goals, and charge relevant healthcare organization departments and individuals to reduce risks.
For occupational health services leaders and staff
Number
Recommendation
Number
3.b.
Recommendation
Conduct, or collaborate with other healthcare organization departments or individuals in, regular risk assessments and risk reduction activities related to occupational infection prevention and control.
Number
3.c.
Recommendation
Notify healthcare organization leaders and departments about hazards identified and risk reduction plans, progress, and priorities for healthcare personnel.
4. Medical Evaluations
For healthcare organization leaders and administrators
Number
Recommendation
Number
4.a.
Recommendation
Provide job descriptions with sufficient detail to assess job-related infection risks to occupational health services staff before the pre-placement medical evaluation.
For occupational health services leaders and staff
Number
Recommendation
Number
4.b.
Recommendation
Develop, review, and update when necessary, policies and procedures for providing preplacement, periodic, and episodic medical evaluations that include health assessments, screening and diagnostic testing, immunization services, exposure and illness management, counseling, and reporting of findings of medical evaluations.
Number
4.c.
Recommendation
For preplacement medical evaluations
Number
4.c.1.
Recommendation
Review each employee’s job description for duties that may affect risk of acquiring or transmitting infections in healthcare settings.
Number
4.c.2.
Recommendation
Collect a directed health inventory to assess:
- history of medical conditions and other factors that may affect the risk of acquiring or transmitting infections in healthcare settings, and
- evidence of immunity to vaccine-preventable diseases recommended for healthcare personnel by the Advisory Committee on Immunization Practices (ACIP).
Number
4.c.3.
Recommendation
Conduct or refer healthcare personnel for physical examination, as indicated, to assess medical conditions that might affect risk of acquiring or transmitting infections in healthcare settings.
Number
4.c.4.
Recommendation
Conduct or refer healthcare personnel for infectious diseases screening as recommended by CDC.
Number
4.c.5.
Recommendation
Test for evidence of immunity to vaccine-preventable infections as recommended by the Advisory Committee on Immunization Practices (ACIP).
Number
4.c.6.
Recommendation
Provide or refer healthcare personnel for services that reduce risks of infectious disease transmission (e.g., immunizations, medical clearance for respirator fit testing).
Number
4.c.7.
Recommendation
Provide or refer healthcare personnel for information regarding:
- health conditions that may increase their risk of acquiring or transmitting infections in healthcare settings, and recommended actions to reduce those risks;
- procedures for preventing and managing workplace exposures and illnesses;
- work restrictions and sick leave policies; and
- confidentiality of their health information.
Number
4.d.
Recommendation
For periodic medical evaluations
Number
4.d.1.
Recommendation
Provide additional doses of vaccines recommended for healthcare personnel by the Advisory Committee on Immunization Practices (ACIP).
Number
4.d.2.
Recommendation
Perform or refer healthcare personnel for indicated follow-up testing.
Number
4.d.3.
Recommendation
Conduct periodic screening for tuberculosis, if indicated, as recommended by CDC.
Number
4.d.4.
Recommendation
Provide or refer healthcare personnel for periodic respirator fit testing, if indicated.
Number
4.e.
Recommendation
For episodic medical evaluations, conduct or refer healthcare personnel for medical evaluations on an as-needed basis to:
Number
4.e.1.
Recommendation
evaluate and manage potentially infectious exposures and illnesses;
Number
4.e.2.
Recommendation
evaluate and manage new health conditions (e.g., pregnancy, rashes) that may affect risk of acquiring or transmitting infections or ability to perform job functions;
Number
4.e.3.
Recommendation
provide pre-placement medical evaluations for healthcare personnel who are changing job duties;
Number
4.e.4.
Recommendation
survey healthcare personnel for exposures and/or illness during outbreaks of infectious diseases in healthcare settings, if indicated.
5. Occupational Infection Prevention and Control: Education and Training
For healthcare organization leaders and administrators
Number
Recommendation
Number
5.a.
Recommendation
Provide healthcare personnel dedicated time during their normal work hours to complete occupational infection prevention and control education and training.
For occupational health services leaders and staff
Number
Recommendation
Number
5.b.
Recommendation
Collaborate with appropriate healthcare organization departments or individuals to:
Number
5.b.1.
Recommendation
Define the goals and scope of education and training for healthcare personnel about occupational infection prevention and control.
Number
5.b.3.
Recommendation
Support initial, periodic, and as-needed education and training that is appropriate in content to the educational level, literacy, and language of healthcare personnel.
Number
5.b.3.
Recommendation
Periodically review healthcare personnel exposure data to identify high risk sub-populations for refresher infection prevention and control education and training.
Number
5.c.
Recommendation
Determine periodic “refresher” education topics based upon analyses of healthcare personnel exposure incident reports, risk assessments, and other methods that identify infectious hazard vulnerabilities for healthcare personnel.
Number
5.d.
Recommendation
Topics for initial, periodic, and as-needed education and training should include:
- Federal, state, and local education and training requirements
- Modes of infectious disease transmission and implementation of standard and transmission-based precautions
- Hand hygiene
- Sharps injury prevention
- Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) for healthcare personnel
- Healthcare personnel screening for selected infectious diseases before job placement and periodically thereafter
- How to access occupational health services, when needed, and expectations for reporting exposures
- Expectations for reporting illnesses or conditions (work-related or acquired outside of work), such as rashes or skin conditions (e.g., non-intact skin on hands); febrile, respiratory, and gastrointestinal illnesses, and hospitalizations resulting from infectious diseases
- Sick leave and other policies and procedures related to infectious healthcare personnel, including the risks of presenteeism to other healthcare personnel and patients
6. Immunization Programs
For healthcare organization leaders and administrators
Number
Recommendation
Number
6.a.
Recommendation
Set goals to achieve high rates of evidence of immunity to vaccine-preventable diseases recommended for healthcare personnel by the Advisory Committee on Immunization Practices (ACIP).
For occupational health services leaders and staff
Number
Recommendation
Number
6.b.
Recommendation
Develop, review, and update when necessary immunization program policies and procedures that:
Number
6.b.1.
Recommendation
Adhere to Advisory Committee on Immunization Practices (ACIP) recommendations for immunizing healthcare personnel.
Number
6.b.2.
Recommendation
Indicate all preplacement, annual, and other job-related immunizations that healthcare personnel should receive.
Number
6.b.3.
Recommendation
Specify strategies to offer vaccines to healthcare personnel and to achieve high immunization coverage.
Number
6.b.4.
Recommendation
Specify strategies for gathering and reviewing information on why recommended immunizations are not administered to inform program quality improvement.
7. Management of Potentially Infectious Exposures and Illnesses
For healthcare organization leaders and administrators
Number
Recommendation
Number
7.a.
Recommendation
Implement sick leave options for healthcare personnel that encourage reporting of potentially infectious exposures or illnesses, appropriate use of sick leave, and adherence to work restrictions.
For leaders and staff of occupational health services
Number
Recommendation
Number
7.b.
Recommendation
Develop, review, and update when necessary policies and procedures about healthcare personnel exposure and illness management services that:
Number
7.b.1.
Recommendation
Include methods to provide job-related exposure and illness management services.
Number
7.b.2.
Recommendation
Establish a timely, confidential, and non-punitive mechanism for healthcare personnel to report potentially infectious exposures and access exposure and illness management services 24 hours a day and 7 days per week.
Number
7.b.3.
Recommendation
Include sick leave options that encourage reporting of potentially infectious exposures and illnesses and that discourage presenteeism.
Number
7.b.4.
Recommendation
Facilitate access to clinical providers with expertise in exposure and illness management who are available 24 hours a day and 7 days per week.
Number
7.b.5.
Recommendation
Facilitate prompt access to laboratory testing and treatment for managing exposures and illnesses.
Number
7.b.6.
Recommendation
Describe work restrictions for exposed or ill healthcare personnel that:
Number
7.b.6.b.
Recommendation
Specify methods of communication between occupational health services, healthcare personnel, and others (e.g., human resources, managers) about work restrictions.
Number
7.b.6.c.
Recommendation
Identify how work restrictions are imposed and healthcare personnel are cleared for return to work.
Number
7.c.
Recommendation
Define criteria, methods, and individuals responsible for reporting potentially infectious exposures and illnesses or suspected infectious outbreaks to internal departments and external authorities.
Number
7.d.
Recommendation
Provide or refer healthcare personnel who have sustained job-related potentially infectious exposures or illnesses for prompt management that includes:
Number
7.d.1.
Recommendation
Evaluating the exposed or ill healthcare personnel.
Number
7.d.2.
Recommendation
Evaluating the exposure incident and source, including whether the source was potentially infectious and whether others remain at risk.
Number
7.d.3.
Recommendation
Arranging for any needed testing.
Number
7.d.4.
Recommendation
Counseling about:
- risk of exposure or illness,
- testing,
- options for and risks and benefits of postexposure prophylaxis or treatment,
- need for specialty care,
- follow-up testing and treatment,
- work restrictions, if indicated,
- risk of transmitting infections to others and methods to prevent transmission, and
- signs and symptoms of illness to report after an exposure, including potential side effects of prophylaxis.
Number
7.d.5.
Recommendation
Offering prophylaxis or treatment, if indicated.
Number
7.d.6.
Recommendation
Offering prophylaxis or treatment, if indicated
8. Management of Healthcare Personnel Health Records
For healthcare organization leaders and administrators
Number
Recommendation
Number
8.a.
Recommendation
Establish systems to maintain confidential work-related healthcare personnel health records, preferably in electronic systems, that:
Number
8.a.1.
Recommendation
limit access only to authorized personnel,
Number
8.a.2.
Recommendation
enable rapid access by authorized clinical providers,
Number
8.a.3.
Recommendation
facilitate aggregation and de-identification of information,
Number
8.a.4.
Recommendation
allow tracking and assessments of trends in infectious risks, screening tests, exposures, and infections, and
Number
8.a.5.
Recommendation
enable confidential reporting to internal departments and individuals or external groups.
Number
8.b.
Recommendation
Consider enabling electronic system features that:
Number
8.b.1.
Recommendation
notify occupational health services when occupational infection prevention and control services are due, and
Number
8.b.2.
Recommendation
communicate work restrictions with other healthcare organization data systems (e.g., human resources information systems).
For leaders and staff of occupational health services
Number
Recommendation
Number
8.c.
Recommendation
Participate in the development of policies and plans that facilitate confidential, efficient exchange of healthcare personnel health information.
Number
8.d.
Recommendation
Maintain healthcare personnel records and databases that include medical evaluations, infectious disease screening, evidence of immunity and immunizations, exposure and illness management, and work restrictions.
Number
8.e.
Recommendation
Maintain confidentiality, use appropriate authorizations, and provide only necessary information when sharing healthcare personnel records.
Number
8.f.
Recommendation
Facilitate healthcare personnel data aggregation for reporting performance measures and supporting occupational health services quality improvement activities.
Number
8.g.
Recommendation
Make copies of individual records promptly available to healthcare personnel upon their request, preferably within 15 days.