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.