The keys: Immunize, follow up, restrict
The keys: Immunize, follow up, restrict
New guidelines for infection control in health care workers issued by the Centers for Disease Control and Prevention include recommendations on immunization, postexposure follow-up, and work restrictions for infected staffers.1 (See charts, p. 4 and insert.)
Issued by the CDC’s Hospital Infection Control Practices Advisory Committee (HICPAC), the guidelines were ranked in the draft version according to the following categories:
Category IA: Strongly recommended for all hospitals and strongly supported by well-designed experimental or epidemiologic studies.
Category IB: Strongly recommended for all hospitals and reviewed as effective by experts in the field and a consensus of HICPAC members based on strong rationale and suggestive evidence, though definitive scientific studies have not been done.
Category II: Suggested for implementation in many hospitals. Recommendations may be supported by suggestive clinical or epidemiologic studies, a strong theoretical rationale, or definitive studies applicable to some, but not all, hospitals.
No Recommendation, Unresolved Issue: Practices for which insufficient evidence or consensus regarding efficacy exists.
The following summarized recommendations on immunization, exposure, and worker restrictions were all ranked IB in the draft version of the guidelines.
Immunization Policies
1. Ensure that persons administering immunizing agents are: familiar with the general [CDC] recommendations on immunizing adults; well informed about indications, storage, dosage, preparation, side effects, and contraindications for each of the vaccines, toxoids, and immune globulins used; and kept updated on professional organization recommendations regarding vaccination of health care personnel.
2. Ensure that immunization product information is available at all times and that a pertinent health history, especially a history of allergy and potential vaccine contraindications, is obtained from each person before an agent is given.
3. Ensure that persons administering immunizing agents are familiar with state and local regulations regarding vaccinations for health care personnel.
4. Formulate a written comprehensive policy on immunizing health care personnel.
5. Develop a data base of employee specific information on history of vaccine preventable diseases and status of vaccine administration.
6. Develop a list of needed immunizations for each employee during screening and an individual plan to provide the necessary vaccines.
7. In the absence of a known occupational exposure, provide personnel with on-site service or refer personnel to their own health care providers for routine non-occupation-related immunizations against diphtheria, pneumococcal disease, hepatitis A, or tetanus.
8. Provide vaccine to personnel who may have occupational exposure to uncommon diseases such as plague, typhus, or yellow fever, or refer them to their own health care providers.
Prophylaxis and Follow-Up After Exposure
1. Ensure that when personnel are offered necessary prophylactic treatment with drugs, vaccines, or immune globulins, they are informed of:
• options for prophylaxis;
• the risk (if known) of infection when treatment is not accepted;
• the degree of protection provided by the therapy;
• and the potential side effects of the therapy.
2. Ensure that when personnel are exposed to particular infectious agents, they are informed of:
• the recommended follow-up based on current knowledge about the epidemiology of the infection;
• the risk (if known) of transmitting the infection to patients, other personnel, or other contacts;
• and the methods of preventing transmission of the infection to other persons.
Personnel Restriction Because of Infectious Illnesses
1. Develop well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions. These policies should govern:
• personnel responsibility in using the health service and reporting illness;
• removal of personnel from contact with patients;
• and clearance for work after an infectious disease that required work restriction.
2. Identify the persons with authority to relieve personnel of duties.
3. Develop work-exclusion policies that encourage personnel to report their illnesses or exposures and that do not penalize them with loss of wages, benefits, or job status.
4. Educate and encourage personnel who have signs and symptoms of a transmissible infectious disease to report their condition promptly to their supervisor and occupational health.
5. Provide appropriate education for personnel on the importance of good hygienic practices, especially handwashing and covering the nose and mouth when coughing and sneezing.
Reference
1. Centers for Disease Control and Prevention. Draft guideline for infection control in health care personnel, 1997; notice. 62 Fed Reg 47,276-47,327.
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