Managing Health Care Workers' Infectious Exposures and Illnesses: CDC's Recommendations

Health care personnel can be exposed to infection through blood, tissues, secretions and other body fluids, contaminated supplies, devices and equipment, surfaces or the air — by needlesticks and other sharps injuries, splashes or sprays onto mucous membranes or broken skin, or inhaled aerosols. They can also catch infections in the community and bring them to work. Managing exposures and illnesses well — prompt assessment and diagnosis, watching for symptoms, and the right care after exposure — prevents infections and their spread, and gives staff a chance to raise concerns about infection, side effects of prophylaxis and work restrictions.

This is section 7 of CDC's guideline Infection Control in Healthcare Personnel, part I, Infrastructure and Routine Practices.

The recommendations

For health care organization leaders

• Offer sick leave that encourages staff to report exposures and illnesses, use sick leave appropriately, and follow work restrictions.

For occupational health services

• Write and keep up to date policies for exposure and illness services that:
• • provide job-related exposure and illness management;
  • give staff a timely, confidential, non-punitive way to report exposures and reach services 24 hours a day, 7 days a week;
  • offer sick leave that encourages reporting and discourages "presenteeism" — working while sick;
  • provide access around the clock to clinicians expert in exposure and illness management;
  • allow prompt lab testing and treatment;
  • set out work restrictions: how they are communicated among occupational health, staff and others such as managers and human resources, how they are imposed, and how staff are cleared to return.
• Define who reports exposures, illnesses and suspected outbreaks — to which internal departments and outside authorities, and how.
• Provide or refer prompt care after a job-related exposure or illness:
• 1. evaluate the person;
  2. evaluate the exposure and its source — was it infectious, and is anyone else at risk?
  3. arrange any testing;
  4. counsel about the risk, testing, the options, risks and benefits of postexposure prophylaxis or treatment, specialty care, follow-up, work restrictions, the risk of passing infection on and how to prevent it, and symptoms — including prophylaxis side effects — to report;
  5. offer prophylaxis or treatment if needed.

Why exposures go unmanaged

• Many exposures still happen despite long-standing rules, and bloodborne exposures are significantly underreported — among trainees, technicians, surgeons, medical staff and nurses — because of time pressure, fear of reprimand, not knowing how to report, and cost. Workers' compensation covers many staff, but not all — volunteers and trainees may miss out.
• Off-site services can be a barrier, and may be too slow when timing is critical, such as after a needlestick from an HIV-infected source.
• Deciding whether an exposure happened means piecing together where, when and how, for how long, and whether protective equipment was used and worked.
• Streamlined reporting helps — some organizations ask patients to sign an advance release allowing bloodborne pathogen testing if a worker is exposed during their care.

Presenteeism

Coming to work sick puts patients and coworkers at risk. It stems from work ethic, workplace culture (not wanting to let colleagues down) or money — no paid sick leave, or leave pooled with vacation. Understanding why staff come in sick can guide solutions, though contract and self-employed staff may follow different rules.

The laws involved

State and local rules may add more.

Expert help, work restrictions and outbreaks

• Expert consultation — for example for HIV or hepatitis C exposures — may not be on site; standing agreements, telemedicine and electronic protocols help.
• Work restrictions keep infectious staff away from work or from patients, or protect staff at higher risk — such as keeping susceptible workers away from patients with varicella zoster when immune staff are available. Reluctance to report, lost pay and staffing shortages make them hard to apply; telework and paid or job-protected leave can soften the impact.
• Outbreaks among staff call for coordination with infection prevention and other departments, notifying public health, involving the lab when testing is needed, and learning lessons afterward.
• Reporting: every state and territory requires reporting of certain infections; exposures caused by faulty devices, such as sharps, can be reported voluntarily to the FDA's MedWatch.

Sources

Based on "7. Management of Potentially Infectious Exposures and Illnesses," Infection Control in Healthcare Personnel, Centers for Disease Control and Prevention; a work of the United States government in the public domain.