Methods

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

This document is an update of four 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; and
• J. The Americans With Disabilities Act.

The sections were updated by experts in occupational health, infectious diseases, and infection prevention and control (IPC). Updates were informed by a systematic review of recent articles published in peer-reviewed journals and databases of systematic reviews, guidelines, and regulations. All updates were vetted at public meetings of the Healthcare Infection Control Practices Advisory Committee (HICPAC) (See Appendix 1. Contributors).

Literature Search Questions

The questions developed to guide the literature search were:

• What service elements are important for occupational health services that aim to prevent transmission of infections among healthcare personnel and patients in the United States?
• What is known about implementing or delivering the following eight infection prevention and control elements of an occupational health service in the United States?
  1. Leadership and management
  2. Communication and collaboration
  3. Assessment and reduction of risks for infection among healthcare personnel populations
  4. Medical evaluations
  5. Occupational infection prevention and control education and training programs
  6. Immunization programs
  7. Management of potentially infectious exposures and illnesses
  8. Management of healthcare personnel health records
• What interventions can improve the delivery or quality of one of the eight elements, or reduce transmission of infections among healthcare personnel and patients in the United States?

Literature Search

The infrastructure and delivery of healthcare to patients, and hence the provision of occupational IPC services to healthcare personnel (HCP), have changed since the publication of the Guideline for infection control in health care personnel, 1998. CDC conducted a targeted literature search for recent articles consistent with current approaches in occupational IPC service delivery to HCP. Search strategies were formulated using a combination of Medical Subject Headings (MeSH) terms and key words to identify literature that focused on at least one of the eight OHS IPC elements. Four searches were performed in MEDLINE, EMBASE, and CINAHL, or the Cochrane Database of Systematic reviews.

Searches sought:

1. Articles published from January 2004 – October 2015 that were indexed in one of three databases (Table A3.1).
2. Articles published from January 2004 – December 2015 that were indexed in one of three databases using different key words (Table A3.2).
3. Meta-analyses and systematic reviews published from January 2004 – December 2015 that were indexed in the Cochrane Database of Systematic Reviews (Table A3.3).
4. Meta-analyses, systematic reviews, and narrative reviews about interventions to increase vaccination coverage among HCP published from January 2004–December 2015 that were indexed in one of three databases (Table A3.4).

In addition to the results of the systematic review, CDC (KI, DK) searched relevant websites and systematic review repositories of government agencies and nongovernmental organizations (Table A3.5) for additional guidelines, regulations, program evaluations, quality improvement initiatives, and systematic reviews.

Article Selection

CDC (MD, KI, DK, AO, KR, DT) conducted the title and abstract screening and the full text review using the below inclusion and exclusion criteria.

Inclusion Criteria: Articles were retrieved if they were:

• research studies, systematic and narrative reviews, meta-analyses, and other reports;
• relevant to an occupational health service element of interest; and
• relevant to prevention of transmission of infections among HCP or between HCP and patients.

Exclusion Criteria: Articles were excluded if they were:

• conference abstracts or unpublished academic dissertations;
• reports of OHS programs not related to HCP or related to dental practices, laboratory personnel, morgues, mortuaries, or in settings where healthcare is not provided; or
• non-U.S.-based studies (except for systematic or narrative reviews on immunization programs).

Figure A3.1 depicts the process of screening and selecting articles. Very few relevant intervention studies were found in indexed databases, and many lacked well-defined interventions, a comparison group, large study size, or longitudinal follow-up.

Recommendation Formulation

The authors formulated recommendations based on current federal regulations, standards, and recommendations, or informed by:

• guidance of nongovernmental organizations;
• qualitative assessment of findings about interventions, service delivery, or quality from the indexed and non-indexed sources reviewed; and
• professional experience and opinions regarding:
  • the benefits, harms, feasibility, and acceptability of interventions to HCO leaders, administrators, OHS staff, and HCP; and
  • the feasibility and applicability of interventions for diverse types of HCP and for varied service delivery models (e.g., provided on-site vs. off-site).

Authors recused themselves from decisions pertaining to the development of recommendations when there was a perceived or actual conflict of interest. HICPAC classified all recommendations as good practice statements based on professional experience and scientific evidence that indicated a high probability that the recommended action would do more good than harm.[1]

Reviewing and Finalizing the Guideline

Drafts of the updated sections and recommendations were presented at public HICPAC meetings in March 2016, July 2016, and December 2016. Input from HICPAC and the public were incorporated into subsequent drafts. The draft recommendations and narrative were provisionally approved by HICPAC at the December 2016 meeting.[2] Following further revisions, CDC then submitted the guideline to CDC clearance and subsequent posting to Regulations.gov for public comment. The comments were compiled and reviewed with a revised draft document at the May 2019 HICPAC meeting. The document was approved by HICPAC on May 17, 2019.

References

1. Guyatt G, Schunemann HJ, Djulbegovic B, et al. Guideline panels should not GRADE good practice statements. J Clin Epidemiol. 2015;68: 597-600. Accessed August 20, 2019.
2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Record of the Proceedings, Healthcare Infection Control Practices Advisory Committee, December 1-2, 2016 [PDF – 139 pages]. Accessed August 20, 2019.

Table A3.1 First Search Strategy for Indexed Articles Published January 2004-October 2015, by Database

Table A3.2 Second Search Strategy for Indexed Articles Published January 2004-December 2015, by Database

Table A3.3 Third Search Strategy for Articles Published January 2004-December 2015 that were Indexed in Cochrane Database of Systematic Reviews

Table A3.4 Fourth Search Strategy for Indexed Articles about Immunization Programs for Healthcare Personnel Published January 2004-December 2015, by Database

Table A3.5 Websites Examined for Government Regulations, Standards, Guidelines, and Other Reports about Occupational Infection Prevention and Control among Healthcare Personnel

Figure A3.1 Results of the Process to Select Relevant Articles