CDC releases final HCW infection guidelines
CDC releases final HCW infection guidelines
Does not address use of safer needle devices
While acknowledging that engineering controls such as safety devices can reduce the frequency of percutaneous injuries among health care workers, the federal Centers for Disease Control and Prevention stops short of discussing the use of those devices in the final version of its new guidelines for infection control in health care personnel.1
A draft version of the guidelines released last year2 drew fire from HCW union officials, who charged that the CDC had failed to recommend or even mention the use of safer needle devices to help reduce sharps injuries. (See Hospital Employee Health, January 1998, pp. 6-7.) The final version seems to be an attempt to assuage critics while postponing a more thorough discussion.
"We gave a little more emphasis to the value of using safety devices, but we didn't actually make a recommendation because there still is not enough information on which ones work and which ones don't," says Elizabeth A. Bolyard, RN, MPH, CIC, an epidemiologist in the CDC's hospital infections program and lead author of the guidelines.
The final document notes that needlestick injuries pose the highest risk of bloodborne pathogens transmission to HCWs, but says "only a few studies evaluating a limited number of safety devices have demonstrated a reduction in percutaneous injuries among health care workers." The guidelines will not address the use of safety devices, the document states, "because the Public Health Service is assessing the need for further guidance on selection, implementation, and evaluation of such devices in health care settings."
The new guidelines also include a number of other modifications from the draft version, as well as additional references. (For extensive information on the draft version, see Hospital Employee Health, December 1997, pp. 133-138.)
For example, work restrictions for employees with oral herpes simplex were changed from excluding those workers from caring for high-risk patients in the draft version to recommending that workers be evaluated for the need to be restricted.
Specifically, the final guidelines state: "Because personnel with orofacial lesions may touch their lesions and potentially transmit infections, they should be evaluated to determine their potential for transmitting herpes simplex to patients at high risk for serious disease." Those patients include neonates, patients with severe malnutrition, those with severe burns or eczema, and immunocompromised patients.
"We sort of waffled on that because there were two entirely different camps: people who say [employees with orofacial lesions] should not work, and people who say, 'We let them work and have never had a problem.' We kind of came out in the middle," Bolyard explains.
Another change relates to scabies recommendations, with the CDC now advising against prophylactic scabicide therapy for HCWs who are exposed to scabies but lack signs of infestation, except in outbreak situations.
(Editor's note: For a complete look at the comprehensive information contained in the guidelines, see Reference No. 1 on p. 122, or send for a free copy from: CDC Hospital Infections Program, Mail Stop E68, 1600 Clifton Road NE, Atlanta, GA 30333. The complete document also is available in PDF format on the CDC's Web site at: http://www.cdc.gov/ncidod/hip/hip.htm.)
References
1. Bolyard EA, Tablan OC, Williams WW, et al. Guideline for infection control in health care personnel, 1998. Am J Infect Control 1998; 26:289-354, and Infect Control Hosp Epidemiol 1998; 19:407-463.
2. Department of Health and Human Services, Centers for Disease Control and Prevention. Draft guideline for infection control in health care personnel, 1997; notice. 62 Fed Reg 47,275 (Sept. 8, 1997).
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