Infection Control Today

JUN 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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20 ICT June 2019 www.infectioncontroltoday.com cover story By Kelly M. Pyrek L ate last year, the Centers for Disease Control and Prevention (CDC) sought feedback from the healthcare community on a draft guideline, Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services. Specifcally, the CDC is looking to "facilitate the provision of occupational infection prevention and control services to healthcare personnel and to prevent transmission of infections between healthcare personnel and others." The CDC is updating two sections addressing protocol for infrastructure and routine practices, which initially were published in 1998. Since 2015, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has collaborated with academics, health professionals, healthcare providers and other partners to update the guidance. "This guidance is not only a crucial tool to improving worker health and safety in healthcare, but a testament to CDC's ongoing focus on this issue," confrm Amber Hogan Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center (ISC), and Elise M. Handelman, BSN, MEd, RN (ret), a board member of the ISC, in comments provided to the CDC. "Often patient safety far overshadows worker safety in healthcare settings and frankly, without healthcare personnel, there is no healthcare. In fact, safer healthcare workers have a direct impact on their ability to provide and maintain safer patient care." Mitchell emphasizes that it is critical for guidance related to occupational health in healthcare refect requirements and messaging from both OSHA and NIOSH. "CDC has historically drafted guidance with little input from either organization," she says. "Guidance must include careful attention to assessing risks and implementing preventive strategies that are established in the hierarchy of controls. Providing examples of how that can be carried out by healthcare facilities would be incredibly benefcial." For example, Mitchell points out: • Elimination: Remove sharp sutures for skin closure where appropriate and replace with zipper technologies, adhesives, strips, or other non-sharps; • Substitution: Replace sharp sutures with blunt-tip sutures for internal fascia closures; replace needles for intravenous connections with needleless connectors. • Engineering controls: Use sharps with injury protections (SIPs), needleless IV systems; use of robotic equipment to reduce risk during invasive procedures when appropriate; Infection Control in Occupational Health: CDC Seeks to Update Guidelines • Administrative and work practice controls: activate a safety feature after use on a SIP device immediately after use, immediately dispose of sharps after use, use "neutral zone" for passing sharps among surgical personnel; ensure that employees receive training on new devices and procedures; • PPE: Use eye protection, face shields, gloves, gowns, etc. to prevent exposures. A number of areas pertaining to occupational health in healthcare need to be bolstered in this guideline, according to the individuals and organizations submitting public comments and feedback to the CDC. Relating to sharps safety and blood and body fuid exposures, Mitchell recommends the following issues be addressed in the updated proposed guideline: • Post-exposure prophylaxis, vaccination/immunization, and employee health records need to be addressed fully. Since HIPAA explicitly excludes employee/employment records; suggest additional research by authors on exclusions in employment relationships, including more careful attention to the requirements set for in OSHA's Access to Employee Exposure and Medical Records and Recordkeeping Standards.

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