CDC Guideline Update: Infection Prevention and Control in Healthcare Personnel

David T. Kuhar, M.D.

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion, Prevention and Response Branch

Core Writing Group Members q  HICPAC

§  Tammy Lundstrom §  Yvette McCarter §  Barbara Soule §  Alexis Elward

q  DHQP-CDC §  David Kuhar

q  CEP, UPHS §  Craig Umscheid §  Gretchen Kuntz

q  ACET liaison to HICPAC

§  Rachel Stricof

q  ACOEM §  Mark Russi

q  SHEA §  Hilary Babcock

q  APIC §  Sue Sebazco

q  IDSA §  Tammy Lundstrom

q  NIOSH §  Bradley King

Document Plan

q  Reminiscent of the original 1998 document §  A ‘hybrid’ document

•  To combine summary and review information in the written text as well as ‘key questions’ to guide new recommendations

•  Retain summary tables as per feedback from users in the occupational health and epidemiology communities

Organization

q  Focus on infection prevention topics q  Avoid duplication of recommendations in other CDC

guidelines §  Immunization of Healthcare Workers (ACIP/HICPAC 1997)

update approved by ACIP in 2/2011 §  Immunization of Healthcare Personnel: Recommendations of

ACIP (2011) •  Currently in CDC clearance

q  Links to include: ACIP, Norovirus, Bloodborne Pathogens, TB guidelines, etc.

Organization

q  3 Main Sections: §  Baseline Infrastructure and Routine Practices

•  Pre-placement immunizations, Annual testing, Booster and annual immunizations, Education, etc.

§  Specific Infectious Diseases: Epidemiology, Prevention, and Control of Selected Infections Transmitted Among HCP and Patients

•  TB, Hepatitis C, pertussis, etc. §  Special HCP populations

•  Pregnancy, Immunocompromised, Lab, Travelling HCP, other

Outline: Section 1

q  Baseline Infrastructure and Routine Practices §  Introduction §  Infection Prevention Objectives for a Personnel Health Service

•  Infection Prevention and Occupational Health Collaboration •  Collaboration with other Departments

§  Elements of a Personnel Health Service for Infection Prevention •  Coordinated Planning and Administration •  HCP Medical Evaluations •  Pre-placement Immunizations •  HCP Health and Safety Education •  Management of Job-related Illnesses and Exposures •  Maintenance of Records, Data Management, and Confidentiality

Outline : Section 2 q  Specific Infectious Diseases- Epidemiology, Prevention, and

Control of Selected Infections Transmitted Among HCP and Patients

GI Infections, Acute Norovirus C. difficile Others

Hepatitis A Herpes Simplex Influenza Measles Meningococcal Disease Multidrug Resistant Gram Negative Bacteria

Isolation Precautions Bloodborne Pathogens

HIV HBV HCV

Conjunctivitis CMV Disease Diptheria

Outline : Section 2 q  Specific Infectious Diseases- Epidemiology, Prevention, and

Control of Selected Infections Transmitted Among HCP and Patients Mumps Parvovirus Pertussis Poliomyelitis Rabies Rubella Scabies and Pediculosis Staphylococcus Aureas

MSSA MRSA

Group A Streptococcus Tuberculosis Vaccinia Varicella Viral Respiratory Infections

RSV SARS Others

Potential Agents of Bioterrorism

Outline : Section 3 q  Special Healthcare Personnel Populations

§  Introduction and Privacy & Related Issues §  Pregnancy §  Immunocompromised HCP

•  HIV Infection •  Transplant Recipients

§  Laboratory Personnel §  Emergency Response Employees §  HCP with Disabilities

•  The Americans with Disabilities Act §  Personnel linked to Infectious Diseases Outbreaks §  Travelling HCP

Identified Research Areas

q  Hepatitis C q  Clostridium difficile q  Pertussis q  MRSA q  Group A streptococcus

Hepatitis C

q  Does treating acute hepatitis C infection in HCP lead to a better treatment response rate than treating Hepatitis C in its chronic phase?

q  What are best practices for monitoring HCP who were exposed to Hepatitis C antibody +, RNA – blood to detect early infection?

Clostridium difficile

q  What is the risk of developing C. difficile infection in exposed healthcare personnel?

q  How long should healthcare personnel with C. difficile infection be furloughed or restricted from work?

Pertussis

q  What is the best method for monitoring exposed HCP for signs of pertussis?

q  In exposed and symptomatic healthcare personnel, what test is the most effective in diagnosing pertussis?

MRSA

q  In non-outbreak settings, does identifying MRSA colonized HCP and decolonizing and/or furloughing them, result in fewer patient or provider MRSA infections? (If the answer is yes, sub-questions below:) §  Should the prevalence of MRSA influence whether to screen/

decolonize/furlough healthcare personnel? §  What is the most effective MRSA decolonization regimen? §  During decolonization, how long is it appropriate to furlough the

MRSA colonized HCP? §  How should successful decolonization of HCP be defined for

them to return to work?

MRSA

q  For HCP epidemiologically linked to an MRSA outbreak, does decolonizing and/or furloughing the HCP, result in control of the outbreak? (If the answer is yes, sub-questions below:) §  What is the most effective MRSA decolonization regimen? §  During decolonization, how long is it appropriate to furlough HCP

who were epidemiologically linked to a MRSA outbreak? §  How should successful decolonization of HCP be defined for

them to return to work?

q  Should HCP with an MRSA or MSSA infection with a draining wound be restricted from patient care activities and if so, for how long?

Group A Streptococcus (GAS) in HCP

q  In HCP exposed to a patient with invasive GAS, does receiving post-exposure prophylaxis decrease the risk of infection?

q  How long should a GAS infected or colonized HCP who is epidemiologically linked to a GAS outbreak be furloughed or restricted from patient care?

q  Under what circumstances should we screen HCP for GAS colonization?

Current Status and Next Steps

q  Completed review of relevant guidelines (49 guidelines) and review articles (77 reviews) to inform key question development

q  Current status §  Finalize Key Questions for literature review. §  Ongoing monthly conference calls §  Continue to identify guidelines which we will link

q  Once literature search has begun, anticipate approximately 12-18 months to guideline completion.

Thank you!

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion, Prevention and Response Branch