Infection Control in Healthcare Personnel
Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2021)
This document supersedes the following sections of Guideline for Infection Control in Healthcare Personnel, 1998, Part E: Epidemiology and Control of Selected Infections Transmitted Among Health Care Personnel and Patients, and their corresponding recommendations in Part II of the 1998 Guideline:
- Diphtheria
- Streptococcus, group A infection
- Meningococcal disease
- Pertussis
Additional updated sections are forthcoming.
Recommendations
1. Diphtheria
Number
Recommendation
Number
1.
Recommendation
For healthcare personnel who have an exposure to diphtheria, regardless of vaccination status,
Number
1.a.
Recommendation
Administer postexposure prophylaxis in accordance with CDC recommendations.
Number
1.b.
Recommendation
Exclude from work and obtain nasal and pharyngeal swabs for diphtheria culture.
Number
1.b.1.
Recommendation
If nasal AND pharyngeal cultures are negative for toxin-producing C. diphtheriae, healthcare personnel may return to work while completing postexposure antibiotic therapy.
Number
1.b.2.
Recommendation
If nasal OR pharyngeal cultures are positive for toxin-producing C. diphtheriae,
Number
1.b.2.a.
Recommendation
Complete postexposure antibiotic therapy.
Number
1.b.2.b.
Recommendation
Healthcare personnel may return to work when:
Number
1.b.2.b.1.
Recommendation
Postexposure antibiotic therapy is completed AND
Number
1.b.2.b.2.
Recommendation
At least 24 hours after completion of postexposure antibiotic therapy, two consecutive pairs of nasal AND pharyngeal cultures, obtained at least 24 hours apart, are negative for toxin-producing C. diphtheriae.
Number
1.c.
Recommendation
Implement daily monitoring for the development of signs and symptoms of diphtheria for 7 days after the last exposure.
Number
2.
Recommendation
For healthcare personnel with respiratory diphtheria infection, exclude from work until:
Number
2.a.
Recommendation
Antibiotic and antitoxin (if needed) therapy are completed AND
Number
2.b.
Recommendation
At least 24 hours after completion of antibiotic therapy, two consecutive pairs of nasal AND pharyngeal cultures, obtained at least 24 hours apart, are negative for toxin-producing C. diphtheriae.
Number
3.
Recommendation
For healthcare personnel with cutaneous diphtheria infection or other diphtheria infection manifestations, determine the duration of exclusion from work in consultation with federal, state, and local public health authorities.
2. Group A Streptococcus
Number
Recommendation
Number
1.
Recommendation
Postexposure prophylaxis and work restrictions are not necessary for healthcare personnel who have an exposure to group A Streptococcus.
Number
2.
Recommendation
For healthcare personnel with known or suspected group A Streptococcus infection, obtain a sample from the infected site, if possible, for group A Streptococcus and exclude from work until group A Streptococcus infection is ruled out, or until 24 hours after the start of effective antimicrobial therapy, provided that any draining skin lesions can be adequately contained and covered.
Number
2.a.
Recommendation
For draining skin lesions that cannot be adequately contained or covered (e.g., on the face, neck, hands, wrists), exclude from work until the lesions are no longer draining.
Number
3.
Recommendation
Work restrictions are not necessary for healthcare personnel with known or suspected group A Streptococcus colonization, unless they are epidemiologically linked to transmission of the organism in the healthcare setting.
Number
4.
Recommendation
For healthcare personnel with group A Streptococcus colonization who are epidemiologically linked to transmission of the organism in the healthcare setting,
Number
4.a.
Recommendation
Administer chemoprophylaxis in accordance with CDC recommendations AND
Number
4.b.
Recommendation
Exclude from work until 24 hours after the start of effective antimicrobial therapy AND
Number
4.c.
Recommendation
Obtain a sample from the affected site for group A Streptococcus testing 7 to 10 days after completion of chemoprophylaxis; if positive, repeat administration of chemoprophylaxis and again exclude from work until 24 hours after the start of effective antimicrobial therapy.
3. Meningococcal Disease
Number
Recommendation
Number
1.
Recommendation
Administer antimicrobial prophylaxis to healthcare personnel, regardless of vaccination status, who have an exposure to N. meningitidis.
Number
2.
Recommendation
Exclude healthcare personnel with invasive N. meningitidis disease from work until 24 hours after the start of effective antimicrobial therapy.
Number
3.
Recommendation
Work restrictions are not necessary for healthcare personnel who only have nasopharyngeal carriage of N. meningitidis.
4. Pertussis
Number
Recommendation
Number
1.
Recommendation
For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and are likely to interact with persons at increased risk for severe pertussis:
Number
1.a.
Recommendation
Administer postexposure prophylaxis.
Number
1.b.
Recommendation
If not receiving postexposure prophylaxis, restrict from contact (e.g., furlough, duty restriction, or reassignment) with patients and other persons at increased risk for severe pertussis for 21 days after the last exposure.
Number
2.
Recommendation
For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and are not likely to interact with persons at increased risk for severe pertussis:
Number
2.a.
Recommendation
Administer postexposure prophylaxis, OR
Number
2.b.
Recommendation
Implement daily monitoring for 21 days after the last exposure for development of signs and symptoms of pertussis.
Number
3.
Recommendation
For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and who have preexisting health conditions that may be exacerbated by a pertussis infection:
Number
3.a.
Recommendation
Administer postexposure prophylaxis.
Number
4.
Recommendation
Exclude symptomatic healthcare personnel with known or suspected pertussis from work for 21 days from the onset of cough, or until 5 days after the start of effective antimicrobial therapy.
Number
5.
Recommendation
Work restrictions are not necessary for asymptomatic healthcare personnel who have an exposure to pertussis and receive postexposure prophylaxis, regardless of their risk for interaction with persons at increased risk for severe pertussis.