While receiving generally favorable reviews, there were plenty of devils in the details in public comments submitted to the CDC on its draft guidance on preventing occupational infections.
The CDC has issued draft guidelines1 for preventing infections in healthcare workers, urging collaboration between infection preventionists and employee health professionals.
(See Hospital Infection Control & Prevention, December 2018.)
The comment period was slated to close Dec. 14, 2018, as this issue went to press. The update comes 20 years after the last CDC guideline on this issue.
“These updates are long overdue, and the care and effort that went into updating the guidance is a notable undertaking,” said Amber Hogan Mitchell, DrPH, MPH, CPH, executive director of the International Safety Center for healthcare workers.
A former Occupational Safety and Health Administration (OSHA) official, Mitchell oversees the center’s EPINet surveillance, which has been gathering data on potentially infectious exposures to healthcare workers for many years.
Safer healthcare workers have a direct impact on their ability to provide and maintain safer patient care, she told the CDC in the comments. “While the document is quite comprehensive, there are elements that are missing and others that need clarification and additional points of accuracy,” Mitchell stated in the comments.
For clarity, she recommended, the CDC should include the term “‘occupational infection and illness’ where appropriate and as frequently as possible together throughout the entire document.”
She added that “‘infection’ is often associated more with healthcare-associated infection, and ‘illness’ is consistent with OSHA terminology.”
Mitchell also suggested that a greater distinction be drawn between occupational duties such as safety and respirator fit testing, compared to employee health functions like post-exposure prophylaxis and vaccinations.
The CDC should drop the use of the term “safety engineered sharps devices” in favor of the more widely used term “sharps with injury protection (SIP),” she advised.
Developed by expert stakeholders, SIP “defines devices with integral features to prevent percutaneous injuries that may cause exposure to blood, body fluids, or other potentially infectious materials,” Mitchell commented.
MRSA Carriage?
In other comments, Kevin T. Kavanagh, MD, MS, of Health Watch USA, said the document does not sufficiently address the risk of healthcare workers becoming carriers of methicillin-resistant Staphylococcus aureus (MRSA) and other drug-resistant pathogens.
“Some of the resistant organisms such as MRSA have become endemic, and different methodologies for prevention of spread need to be instituted, such as routine periodic screening for carriers,” Kavanagh noted in the comments.
To clarify, the CDC has not yet published the guideline section on specific pathogens with important implications for occupational health.
That portion was expected to follow the recently published infrastructure section, and thus a draft likely will be issued in 2019.
The pathogen section of the update should better speak to MRSA concerns, as Healthcare Infection Control Practices Advisory Committee discussions included colonization and screening issues for healthcare personnel and patients.
Other multidrug-resistant bacteria will be addressed in that section, as well as bloodborne pathogens, tuberculosis, and a broad array of respiratory viruses.
Another commenter raised the issue that some physicians are not “employees” of a hospital, creating confusion about whether they are expected to comply with the recommendations.
“It is important and pertinent to explicitly state that providers and physicians must be involved in all healthcare personnel occupational health and infection prevention activities,” said Julie Babyar, RN, MPH.
“Providers and physicians must be required to submit and follow all vaccination, immunization, TB, and exposure documentation,” she said.
In a point relevant to expanding occupational infection prevention beyond hospitals, she said safe injections must be treated like clinical practices.
“The practice of providing injections continues to be performed in many sites as part of an office day, often with HCP walk-ins at random, [and without] clinic rooms.”
The massive shift in the delivery of care over the last two decades requires an emphasis at the onset that employee health programs are critical across the continuum, says David Kuhar, MD, a medical epidemiologist in the CDC’s Division of Healthcare Quality Promotion who is spearheading the process.
In addition, two new elements in the CDC infrastructure guidelines are “leadership and management,” and “assessment of reductions of risk for infection” among healthcare workers, he explains.
“We have recommendations that are aimed at senior leaders and management that [emphasize] providing administrative support as well as resource allocation,” Kuhar says.
“These services can’t be provided unless they are appropriately funded.”
The CDC draft guidelines recommend that healthcare organization leaders create a culture that prioritizes prevention of infections.
They should also regularly review infectious risks with occupational health services and provide adequate staffing and program funding.
- CDC. Healthcare Infection Control Practices Advisory Committee. Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention Services. Oct. 15, 2018. Available at: https://bit.ly/2JsbUPF.
