Health care workers can catch infections at work — and pass them on to patients, colleagues and family. CDC's guideline Infection Control in Healthcare Personnel (Part I, Infrastructure and Routine Practices) sets out how occupational health services should evaluate them medically throughout their employment. This section covers medical evaluations; exposures and illnesses are covered in section 7.
What evaluations are for
- making sure workers have recommended evidence of immunity to vaccine-preventable diseases;
- assessing and managing health conditions, work-related or not, that affect safety at work;
- preventing, evaluating and managing infectious exposures and illnesses;
- individual counseling — on the risk of catching or spreading infections, post-exposure prophylaxis, staying home when sick, and conditions such as pregnancy, HIV or other immunocompromise that change a worker's risk.
The recommendations
Leaders and administrators (4.a): give occupational health staff job descriptions detailed enough to judge each job's infection risks before the pre-placement evaluation.
Occupational health (4.b): keep policies for pre-placement, periodic and episodic evaluations covering health assessments, screening and testing, immunization, exposure and illness management, counseling, and reporting.
| Evaluation | When | What to do |
|---|---|---|
| Pre-placement (4.c) | before starting work | review the job for infection risks; take a health history, including conditions that affect risk and immunity to the vaccine-preventable diseases the Advisory Committee on Immunization Practices (ACIP) recommends for health care workers; arrange a physical exam as needed; screen for infections as CDC recommends; test for immunity; provide immunizations and respirator fit-test clearance; and inform the worker about risky conditions, exposure procedures, work restrictions and sick leave, and confidentiality |
| Periodic (4.d) | during employment | give additional vaccine doses; follow-up testing; periodic tuberculosis screening and respirator fit testing, where indicated |
| Episodic (4.e) | as needed | evaluate and manage exposures and illnesses; new conditions such as pregnancy or rashes that affect infection risk or the ability to work; job changes; and surveys of workers during outbreaks |
Pre-placement evaluations also document a worker's baseline health, give clearance for duty, and explain what occupational health expects and offers.
Access and confidentiality
- On-site services are ideal — point-of-care testing (such as for HIV), follow-up after sharps injuries, illness evaluations. They speed the handling of contagious illness, build trust, and keep the workforce stable. Off-site services can make urgent care, such as deciding on post-exposure prophylaxis after a bloodborne exposure, harder to reach in time.
- Electronic records speed access and support risk assessment, but need strict access controls. Sharing identifiable health information may require authorization (for example under HIPAA) or fall under regulations such as OSHA's.
The law
| Americans with Disabilities Act (ADA) | employers can't require medical evaluations or ask about disabilities before a job offer; limits questions about employees' illnesses and possible disabilities; requires reasonable accommodation |
| OSHA Bloodborne Pathogens standard | offer hepatitis B vaccination before work starts, and evaluation and follow-up after any bloodborne exposure |
| OSHA Respiratory Protection standard | initial medical evaluation, fit testing, training, and re-evaluation when indicated |
| State and local rules | some add medical or functional requirements |
Sources
Based on "4. Medical Evaluations," Infection Control in Healthcare Personnel, Part I: Infrastructure and Routine Practices, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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