Update to the Guideline for Infection Control in Healthcare Personnel, 1998 David T. Kuhar, M.D. Medical Officer Division of Healthcare Quality Promotion HICPAC Meeting July 14, 2017 National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion, Prevention and Response Branch
Outline Background on the 1998 Guideline Section 1 Update Status Section 2 Update- Staphylococcus aureus Plans for update Questions for systematic literature review Input from HICPAC Status
Background: Guideline for Infection Control in Healthcare Personnel, 1998 Audience for recommendations: occupational health providers working in healthcare settings General topics addressed Infrastructure and routine practices for occupational infection prevention services Epidemiology and prevention of selected infections transmitted among healthcare personnel (HCP) and patients For selected pathogens, described methods to prevent transmission among HCP and patients, e,g., o preplacement screening and immunizations o managing HCP exposures and illness, including work restrictions Special populations (e.g., pregnant HCP, emergency-response personnel)
Features of the Updated Guideline 2 main sections Infrastructure and routine practices for occupational infection prevention services Epidemiology and prevention of selected infections transmitted among HCP and patients Segmental update Electronic document posted on the CDC/DHQP website Content to refer to existing guidance, when applicable HICPAC input and public comment
Section 1: Infrastructure and Routine Practices for Occupational Infection Prevention Services Incorporated revisions recommended at the last HICPAC meeting Currently in CDC clearance Next steps Clearance revisions Public comment
Section 2: Epidemiology and Prevention of Selected Infections Transmitted Among HCP and Patients Introduction/Review of isolation precautions Specific pathogens: Bloodborne Pathogens (HIV, HBV, HCV) Conjunctivitis Cytomegalovirus Diphtheria Acute GI Infections (Norovirus, C. diff, others) Hepatitis A Herpes Simplex Measles Meningococcal Disease Multidrug-Resistant Gram Negative Bacteria Mumps Parvovirus Pertussis Poliomyelitis Rabies Rubella Scabies and Pediculosis Staphylococcus aureus (MSSA/MRSA) Streptococcus (group A) Tuberculosis Vaccinia Varicella Viral Respiratory Infections (Influenza, RSV, others) Potential Agents of Bioterrorism (e.g., Anthrax)
Section 2: Writing Group Members CDC David Kuhar (DHQP) Marie De Perio (NIOSH) HICPAC Hilary Babcock Other Experts Ruth Carrico Tammy Lundstrom Mark Russi (ACOEM) Connie Steed (APIC) Tom Talbot Michael Tapper David Weber (SHEA)
Section 2: Outline for each Pathogen Subsection Background/Epidemiology: pathogen, disease manifestations, transmission in healthcare settings, incubation period, period of communicability Information on preventing transmission and acquisition (e.g., link to recommended isolation precautions, vaccination) HCP screening and diagnosis Management of colonized, exposed, and infected HCP (e.g., postexposure prophylaxis, work restrictions) Role of Occupational Health Services in outbreaks involving HCP
Background Staphylococcus Aureus Section Description of MSSA/MRSA Nosocomial transmission Incubation periods (when relevant) Colonization of HCP Body sites of colonization Screening to detect colonized HCP Decolonization Work restrictions
Evidence Base for Pathogen Updates Compile information (supported with literature review as needed) on selected topics Rates of pathogen colonization in adults and HCP in U.S. Disease manifestations Transmission in healthcare settings Identify important questions not addressed by recent federal guidance Conduct systematic literature review for these questions
Staphylococcus Aureus Questions for Systematic Literature Review (5) In healthcare settings without a concurrent MSSA/MRSA outbreak or transmission between patients, patients and HCP, or HCP to HCP: Q1: For HCP with laboratory-confirmed MSSA/MRSA infection, which interventions reduce MSSA/MRSA infections or colonization among patients and/ or other HCP? Q2: For asymptomatic HCP, does screening for MSSA/MRSA colonization lead to implementing interventions that prevent MSSA/MRSA infections or colonization among patients and/ or other HCP?
Staphylococcus Aureus Questions for Systematic Literature Review (5) In healthcare settings with a concurrent MSSA/MRSA outbreak or transmission between patients, patients and HCP, or HCP to HCP: Q3: For HCP with laboratory-confirmed MSSA/MRSA infection, which interventions reduce MSSA/MRSA infections or colonization among patients and/ or other HCP? Q4: For MSSA/MRSA colonized HCP, which interventions reduce MSSA/MRSA infections or colonization among patients and/ or other HCP? Q5: For asymptomatic HCP, which anatomic sites of MSSA/MRSA colonization have the highest risk of transmission to patients and/ or other HCP?
Discussion of Questions for Systematic Literature Review Should any questions be modified or removed? Are there important topics missing that should be addressed with additional questions?
Staphylococcus Aureus Section Status Systematic Literature Review- includes non-u.s. literature Articles identified (approx. 4000) Title and abstract review Finalize full Text review (approx. 460) Next steps Data extraction and evaluation Draft Update
Next Sections Measles (concurrently with mumps and rubella due to the MMR vaccine cluster) Pertussis (concurrently with diphtheria due to the Tdap vaccine cluster)
Thank you! For more information, please contact David T. Kuhar, Centers for Disease Control and Prevention Email: dkuhar@cdc.gov 1600 Clifton Road NE, Atlanta, GA 30333 The findings and conclusions in this presentation are those of the author 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