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Guideline for Infection Control in Health Care Personnel, 1998

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Guideline for Infection Control in Health Care Personnel, 1998 SPECIAL ARTICLE Guideline for infection control in health care personnel, 1998 Elizabeth A. Bolyard, RN, MPH,a Ofelia C. Tablan, MD,a Walter W. Williams, MD,b Michele L. Pearson, MD,a Craig N. Shapiro, MD,a Scott D. Deitchman, MD,c and The Hospital Infection Control Practices Advisory Committee Centers for Disease Control and Prevention Montefiore Medical Center Public Health Service Bronx, New York U.S. Department of Health and Human Services Mary J. Gilchrist, PhD Hospital Infection Control Practices Advisory Committee University of Iowa Membership List, June 1997 Iowa City, Iowa Chairman Elaine L. Larson, RN, PhD Walter J. Hierholzer, Jr., MD Georgetown University Yale-New Haven Hospital Washington, D.C. New Haven, Connecticut James T. Lee, MD, PhD Executive Secretary University of Minnesota Michele L. Pearson, MD VA Medical Center Centers for Disease Control and Prevention St. Paul, Minnesota Atlanta, Georgia Personnel Health Guideline Sponsor Rita D. McCormick, RN Susan W. Forlenza, MD University of Wisconsin Hospital and Clinics New York City Department of Health Madison, Wisconsin New York, New York Ramon E. Moncada, MD Members Coronado Physician’s Medical Center Audrey B. Adams, RN, MPH Coronado, California a Affiliations: National Center for Infectious Diseases, National Ronald L. Nichols, MD Immunization Program,b National Institute of Occupational Safety Tulane University School of Medicine and Health.c New Orleans, Louisiana Published simultaneously in AJIC: American Journal of Infection Control (1998;26:289-354) and Infection Control and Hospital Jane D. Siegel, MD Epidemiology (1998;19:407-63) University of Texas Southwestern Medical Center 17/52/88841 Dallas, Texas Table of Contents I. Infection control issues for health care personnel: An overview A. EXECUTIVE SUMMARY 291 B. INTRODUCTION 292 C. INFECTION CONTROL OBJECTIVES FOR A PERSONNEL HEALTH SERVICE 292 D. ELEMENTS OF A PERSONNEL HEALTH SERVICE FOR INFECTION CONTROL 293 1. Coordination with other departments 293 2. Medical evaluations 293 3. Personnel health and safety education 293 4. Immunization programs 296 5. Management of job-related illnesses and exposures 298 6. Health counseling 301 7. Maintenance of records, data management, and confidentiality 301 E. EPIDEMIOLOGY AND CONTROL OF SELECTED INFECTIONS TRANSMITTED AMONG HEALTH CARE PERSONNEL AND PATIENTS 302 1. Bloodborne pathogens 302 289 AJIC 290 CDC Personnel Health Guideline June 1998 a. Overview 302 b. Hepatitis B 302 c. Hepatitis C 304 d. Human immunodeficiency virus 305 2. Conjunctivitis 305 3. Cytomegalovirus 305 4. Diphtheria 306 5. Gastrointestinal infections, acute 307 6. Hepatitis A 308 7. Herpes simplex 309 8. Measles 309 9. Meningococcal disease 310 10. Mumps 311 11. Parvovirus 311 12. Pertussis 312 13. Poliomyelitis 313 14. Rabies 313 15. Rubella 314 16. Scabies and pediculosis 315 17. Staphylococcus aureus infection and carriage 316 18. Streptococcus, group A infection 316 19. Tuberculosis 316 20. Vaccinia (smallpox) 320 21. Varicella 320 22. Viral respiratory infections 323 a. Influenza 323 b. Respiratory syncytial virus 323 c. Work restrictions 324 F. PREGNANT PERSONNEL 324 G. LABORATORY PERSONNEL 324 H. EMERGENCY-RESPONSE PERSONNEL 325 I. LATEX HYPERSENSITIVITY 325 J. THE AMERICANS WITH DISABILITIES ACT 327 II. Recommendations for prevention of infections in health care personnel 328 A. INTRODUCTION 328 B. ELEMENTS OF A PERSONNEL HEALTH SERVICE FOR INFECTION CONTROL 328 1. Coordinated planning and administration 328 2. Placement evaluation 328 3. Personnel health and safety education 329 4. Job-related illnesses and exposures 329 5. Record keeping, data management, and confidentiality 329 C. PROTECTION OF PERSONNEL AND OTHER PATIENTS FROM PATIENTS WITH INFECTIONS 330 D. IMMUNIZATION OF HEALTH CARE PERSONNEL, GENERAL RECOMMENDATIONS 330 E. PROPHYLAXIS AND FOLLOW-UP AFTER EXPOSURE, GENERAL RECOMMENDATIONS 330 F. PERSONNEL RESTRICTION BECAUSE OF INFECTIOUS ILLNESSES OR SPECIAL 330 CONDITIONS, GENERAL RECOMMENDATIONS G. PREVENTION OF NOSOCOMIAL TRANSMISSION OF SELECTED INFECTIONS 330 1. Bloodborne pathogens, general recommendation 330 a. Hepatitis B 331 b. Hepatitis C 331 c. Human immunodeficiency virus 331 2. Conjunctivitis 331 3. Cytomegalovirus 331 4. Diphtheria 331 AJIC Volume 26, Number 3 CDC Personnel Health Guideline 291 5. Gastroenteritis 332 6. Hepatitis A 332 7. Herpes simplex 332 8. Measles 332 9. Meningococcal disease 333 10. Mumps 333 11. Parvovirus 333 12. Pertussis 333 13. Poliomyelitis 333 14. Rabies 334 15. Rubella 334 16. Scabies and pediculosis 334 17. Staphylococcal infection or carriage 334 18. Group A Streptococcus infections 334 19. Tuberculosis 335 20. Vaccinia 337 21. Varicella 337 22. Viral respiratory infections 337 H. SPECIAL ISSUES 338 1. Pregnancy 338 2. Emergency-response employees 338 3. Personnel linked to outbreaks of bacterial infection 338 4. Latex hypersensitivity 338 References 339 Table 1. Immunobiologics and schedules for health care personnel 294 Table 2. Summary of ACIP recommendations on immunization of health care workers with special conditions 298 Table 3. Summary of suggested work restrictions for health care personnel exposed to or infected with infectious diseases of importance in health care settings, in the absence of state and local regulations 299 Table 4. Recommendation for postexposure prophylaxis for percutaneous or permucosal exposure to hepatitis B virus, United States 303 Table 5. Selected reported etiologic agents causing community or nosocomially acquired gastrointestinal 307 infections in developed countries Table 6. Pregnant health care personnel: Pertinent facts to guide management of occupational exposures to 322 infectious agents Appendix A. Recommended readings for infection control in health care personnel 354 Part I. Infection control issues for health care personnel: An overview A. EXECUTIVE SUMMARY Control Practices Advisory Committee members. This guideline updates and replaces the previ­ A working draft of this guideline was also ous edition of the Centers for Disease Control and reviewed by experts in infection control, occupa­ Prevention (CDC) “Guideline for Infection Control tional health, and infectious diseases; however, all in Hospital Personnel,” published in 1983. The recommendations contained in the guideline may revised guideline, designed to provide methods not reflect the opinion of all reviewers. for reducing the transmission of infections from This document focuses on the epidemiology of patients to health care personnel and from per­ and preventive strategies for infections known to sonnel to patients, also provides an overview of be transmitted in health care settings and those the evidence for recommendations considered for which there are adequate scientific data on prudent by consensus of the Hospital Infection which to base recommendations for prevention. AJIC 292 CDC Personnel Health Guideline June 1998 The prevention strategies addressed in this docu­ Throughout this document, terms are used to ment include immunizations for vaccine-pre­ describe routes of transmission of infections. ventable diseases, isolation precautions to pre­ These terms have been fully described in the vent exposures to infectious agents, management “Guideline for Isolation Precautions in of health care personnel exposure to infected per­ Hospitals.”3 They are summarized as follows: sons, including postexposure prophylaxis, and direct contact refers to body surface–to–body sur­ work restrictions for exposed or infected health face contact and physical transfer of microorgan­ care personnel. In addition, because latex barri­ isms between a susceptible host and an infected ers are frequently used to protect personnel or colonized person (e.g., while performing oral against transmission of infectious agents, this care or procedures); indirect contact refers to con­ guideline addresses issues related to latex hyper­ tact of a susceptible host with a contaminated sensitivity and provides recommendations to pre­ object (e.g., instruments, hands); droplet contact vent sensitization and reactions among health refers to conjunctival, nasal, or oral mucosa con­ care personnel. tact with droplets containing microorganisms generated from an infected person (by coughing, B. INTRODUCTION sneezing, and talking, or during certain proce­ In the United States, there are an estimated 8.8 dures such as suctioning and bronchoscopy) that million persons who work in health care profes­ are propelled a short distance; airborne transmis­ sions and about 6 million persons work in more sion refers to contact with droplet nuclei contain­ than 6000 hospitals. However, health care is ing microorganisms that can remain suspended in increasingly being provided outside hospitals in the air for long periods or to contact with dust facilities such as nursing homes, freestanding sur­ particles containing an infectious agent that can gical and outpatient centers, emergency care clin­ be widely disseminated by air currents; and, final­ ics, and in patients’ homes or during prehospital ly, common vehicle transmission refers to contact emergency care. Hospital-based personnel and with contaminated items such as food, water, personnel who provide health care outside hospi­ medications, devices, and equipment. tals may acquire infections from or transmit In 1983 the CDC published the “Guideline for infections to patients, other personnel, household Infection Control in Hospital Personnel.”4 The members, or other community contacts.1,2 document focused
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