© IFIC:2008
Occupational Health Risks for
Healthcare Workers (HCW)
BASIC CONCEPTS OF INFECTION CONTROL
International Federation of
Infection Control
© IFIC:2008
Reducing Occupational Risks
for HCWs
Assess infection risks, prioritise
prevention measures
Educate about safety & infection
prevention related to specific risks
Investigate HCW exposures and postexposure
management
Collect & analyze reports of HCW
blood exposures and develop
prevention strategies based on the
data
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Understanding HCW Risks
HCWs are exposed to a variety of
diseases and pathogens that they can
acquire and also transmit.
Occupational Health Departments or
services reduce risks to the HCWS,
minimize subsequent disease and
recommend funding for the facility
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Risk Assessment
Consists of two components:
Organizational risk assessment which
determines policy and procedure (e.g.
Occupational Health policies on reporting
sharps injuries, or policies regarding
vaccination and pre-employment screening
Individual healthcare worker risk
assessment with each patient interaction
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Hierarchy of Controls to Minimize
Risk of Infection
Engineering Control
Sharps devices for blood borne infections, air
handling systems for airborne diseases
Most desirable form of compliance
Administrative Controls
Policy and procedure development; safety culture,
providing fiscal and human resources
Occupational Health plays a large role here
Individual Controls
Personal protective equipment; hand hygiene
Least reliable as depends on worker compliance
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General Measures for OH Service
to Reduce Infection Risk
1. Keep easily retrieved OH records for
all employees
2. Screen new employees for
communicable disease history,
educate and immunize
3. Provide infection assessment and
guide work restrictions for staff with
infectious diseases or exposures
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General Measures for OH Service
to Reduce Infection Risk
4. Manage the occupational blood
exposure program in the facility
Develop accident reporting forms
from which data can be analyzed
Identify potentially preventable risks
from the data, recommend changes
in practices or products
Participate in product evaluation for
safety to HCWs
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Measures to Prevent Contact
Transmission
1. Wash hands when they are likely to
have been soiled and between patients
2. Use alcohol hand rubs when hands are
not visibly soiled and between patients
3. Wear sterile gloves for contact with
normally sterile body sites
4. Wear clean gloves for contact with
mucous membranes and non-intact skin
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Measures to Prevent Contact
Transmission
5. Use gloves (recycled or household
gloves OK) for contact with moist
body substances and objects soiled
with MBS
6. Use barrier precautions (masks,
eyewear, gowns or aprons) when
spatter is likely
7. Handle all clinical specimens as if
infectious
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Measures to Prevent Contact
Transmission
8. Handle linen and trash to
avoid skin contact & protect
subsequent handlers
9. Clean & disinfect
appropriately all items used
between patients
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Specific Measures to Prevent
Airborne Disease Transmission
1. Restrict susceptible personnel and
patient or family contacts when
possible
2. Use effective masks or ventilator-type
masks for tuberculosis when necessary
They are expensive and often unavailable
They may not protect susceptibles from all
airborne communicable diseases
3. Surgical masks may have little benefit
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Post-Exposure Disease
Prevention
It is much better to prevent exposure
whenever possible than to manage
post-exposure treatment
Also less expensive: post-exposure
management of a single puncture in
the US now costs more than $300
McCormick et al. Am J Med 199;91(Suppl 3B):301-307
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Post-Exposure Disease
Prevention: Occupational
1. Define “exposure” for the disease
2. Identify exposed employees and
volunteers
3. Schedule 1st visits for baseline or
prophylaxis immediately: sooner is
better
4. Keep records to allow retrieval of
information
5. Publicise as necessary
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Post-exposure Management
for Bloodborne Diseases
Baseline: test source for HBV, HCV,
HIV
Test recipient for same
If high risk exposure for HIV,
prophylaxis for HIV is indicated
immediately (within hours)
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Post-exposure Management
for Bloodborne Diseases
If employee is HBV susceptible, 1st
dose of HBV vaccine +HBIG is
indicated (within hours)
Schedule follow-ups as indicated
Give instructions for sexual contact
precautions
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Limiting or Preventing
Occupational Exposures
Identify personnel at high risk
Use methods that limit exposures from
all patients rather than only diagnosed
cases: safe injection for all patients,
coughing patient precautions, gloves for
contact with all moist body substances,
etc.
Provide appropriate education for all
personnel
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Specific Agents
RareRareCytomegalovirus
(CMV)
HighHighConjunctivitis, viral
(e.g., adenovirus)
ModerateModerateLocalized
varicella-zoster
(shingles)
HighHighChickenpox,
dissemin. zoster
Patient → StaffStaff → PatientInfection
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Specific Agents
Low (risk from
puncture: 1-7%)
RareHepatitis C
Moderate (risk
from puncture: 6-
35%)
LowHepatitis B
RareRareHepatitis A
Moderate (risk
from puncture
unknown)
LowHemorrhagic fever
(Ebola & Marburg
virus)
Patient → StaffStaff → PatientInfection
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Specific Agents
HighHighMeasles
ModerateModerateInfluenza
Rare (risk from
puncture: 0.03%)
Very RareHuman
immunodeficiency
virus (HIV)
LowRareHerpes simplex
Patient → StaffStaff → PatientInfection
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Specific Agents
ModerateModerateRespiratory
syncytial virus
ModerateModeratePertussis
ModerateModerateMumps
RareNone reportedMeningococcal
infection
Patient → StaffStaff → PatientInfection
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Specific Agents
LowLowScabies
No dataRareStaphylococcus
aureus (includes wound
and skin infection)
LowLowSalmonella or
Shigella
ModerateModerateRubella
ModerateModerateRotavirus
Patient → StaffStaff → PatientInfection
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Administrative Support for
Occupational Health
Mandate from administration must
define responsibility, lines of
communication, and authority
Clinical and laboratory support for
outbreak investigation
Policies for mandatory work exclusion,
workload and funding
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Occupational Health
Like Infection Prevention Programs, is
often quick to show value
Properly managed, is often cost-
effective
May save lives and reduce risk for
serious illness among expensive, hard
to replace employees
May provide benefit out into the
community
© IFIC:2008
Key Points
Assess infection risks to personnel and
prioritise preventive measures
Implement an education programme
about safety and infection prevention
related to the specific risks of work in
the facility
Determine susceptibility to vaccine
preventable diseases and implement an
appropriate immunisation programme
© IFIC:2008
Key Points
Conduct exposure investigations
including review of post-exposure
management
Implement surveillance of occupational
blood exposures and develop
prevention strategies for high-risk
practices or departments
© IFIC:2008
References and Further Reading
Herwaldt LA, Pottinger JM, Carter CD, et al. Exposure
Workups. Infect Control Hosp Epidemiol 1997;18:850-71
Decker MD, Schaffner W. Chapter 65: Nosocomial
diseases of health care workers spread by the airborne
or contact routes (other than tuberculosis). In: Mayhall
CG, editor. Hospital Epidemiology and Infection Control.
Baltimore: Williams & Wilkins; 1996. p.859-83
CDC. Guideline for infection control in health care
personnel [online] 1998 [cited 2007 August 10).
Available from: URL:
http://www.cdc.gov/ncidod/dhqp/gl_hcpersonnel.html
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References and Further Reading
Falk, P. Chapter 83: Infection control and the employee
health service. In: Mayhall CG, editor. Hospital
Epidemiology and Infection Control. Baltimore: Williams
& Wilkins; 1996. p. 1094-9
Prevention and Control of Occupational Infections in
Health Care, Public Health Agency of Canada, Health
Canada [online]. 2002 [cited 2007 August 10]. Available
from: URL: http://www.phac-aspc.gc.ca/publicat/ccdr-
rmtc/02vol28/28s1/index.html
© IFIC:2008
References and Further Reading
Lynch P. Managing employee and patient exposures in
health care settings. In: Lynch P, Jackson MM, Preston
GA, Soule BM. Editors. Infection prevention with limited
resources: A handbook for infection committees.
Chicago: Etna Publications; 1997
Sheretz RJ, Marosok RD, Streed SA. Chapter 14:
Infection control aspects of hospital employee health. In:
Wenzel RP editor. Prevention and Control of Nosocomial
Infections, 2nd edition. Baltimore: Williams & Wilkins;
1993. p. 295-332