Prevention of occupationally acquired infections among heath-care workers.

Abstract

1. Chia Yin Chong, MBBS* 2. Donald A. Goldmann, MD† 3. W. Charles Huskins, MD, MS† 1. 2. *Division of Infectious Diseases, Children’s Hospital, Boston, MA. 3. 4. †Division of Infectious Diseases and Department of Pediatrics, Harvard Medical School, Boston, MA. 1. Health-care workers should have immunity to five vaccine-preventable diseases (measles, mumps, rubella, varicella, hepatitis B) determined during preplacement screening. 2. Health-care workers who have been exposed to active pulmonary or laryngeal tuberculosis and do not have a previous history of a positive purified protein derivative (PPD) or treatment for tuberculosis should have PPD skin tests performed at baseline; if negative, they should be repeated 12 weeks after exposure. 3. Health-care workers should receive annual vaccination against influenza because they care for patients who may be at high risk for serious morbidity and mortality from influenza, because immunity to particular subtypes of influenza is relatively short-lived, and because the antigenic composition of circulating subtypes changes from year to year. 4. A detailed history is required to determine the appropriate management of health-care workers who have suffered a percutaneous exposure to blood and should include the depth of penetration, the type of instrument causing the injury, previous contact of the instrument with the source patient’s blood, a history of documented infection or risk factors for infection with a bloodborne virus in the source patient, and a detailed history of hepatitis B vaccination of the worker. 5. The efficacy of postexposure prophylaxis for human immunodeficiency virus infection has not been established, but it is supported by several indirect lines of evidence. Hospitals and medical clinics are favorable settings for the transmission of infectious diseases because infected and susceptible persons are brought into close proximity. Health-care workers (HCW) are at particular risk because their work demands close contact with patients who may be harboring pathogenic microorganisms. This article focuses on the prevention of occupationally acquired infectious diseases among HCW, although it should be recognized that a comprehensive occupational health program also reduces the risk of hospital-acquired infection among patients. Occupational infections among microbiology laboratory workers that are not …