The expanding horizons of infection control.

Abstract

In this issue of Infection Control and Hospital Epidemiology, Gershon and colleagues address the occupational risk for bloodborne infections in a group of funeral practitioners.' The significance of this report is twofold. First, the study noted a low rate of occupational exposures and a high rate of hepatitis B vaccination in comparison with prior studies, which suggests improved compliance with recommendations for preventing transmission of bloodborne pathogens in the workplace. Second, and more importantly, this study illustrates the increasing awareness that the risk for bloodborne infections or other infections transmitted from patients to healthcare workers2 is not limited to those who are employed in a hospital setting. It is this issue that will be addressed in this editorial. There are a number of different mechanisms by which infections may be transmitted from patients to healthcare workers. Hepatitis (B and C) and HIV have refocused attention on bloodborne infections,3,4 which in turn has resulted in OSHA regulations for the prevention of such infections.5 The reemergence of tuberculosis6 to include multidrug-resistant isolates7 already has altered previous Centers for Disease Control and Prevention guidelines,s as well as OSHA guidelines for the wearing of protective masks,9 and undoubtedly will result in comprehensive OSHA regulations for the prevention of airborne infections.10 As would be expected, occupationally acquired infections in healthcare workers have received the greatest attention for workers in the hospital setting. The result has been an extensive system for infection control in the hospital setting to include infection control practitioners, policies, programs, research, and meetings, as well as textbooks, and, of course, journals such as this one. Moreover, the horizons of infection control are expanding because of the recognition that the risk of infections transmitted from patients to healthcare workers is not limited to those who work in a hospital setting, but extends to both prehospital and posthospital healthcare workers. This realization seems to have had a beneficial effect on funeral home workers in Maryland.1 Examples of prehospital and posthospital healthcare workers at risk for occupationally acquired infections include clinic healthcare workers, home healthcare workers,11 nursing home workers,12 trash haulers and landfill operators,13 and prosectors/ forensic pathologists.14 The most common and important mechanisms are exposure to aerosols, exposure to blood or body fluids via direct contact or inoculation, and hand-to-mouth transmission. Infectious agents of particular concern to healthcare workers include HIV-1, hepatitis B virus, hepatitis C virus, rabies virus, Mycobacterium tuberculosis, methicillinresistant Staphylococcus aureus, group A streptococcus, and the Creutzfeldt-Jacob disease agent. A number of points can be made about these healthcare workers, the routes of transmission, and certain infectious agents. Pathologists, although generally considered hospital workers, clearly are at risk when performing an autopsy15 such as in a medical examiner's office. Bloodborne pathogens have become a major concern to prosectors and efforts have been made to reduce this risk.16 Less appreciated in this group is the risk for airborne infection during an autopsy. Consider, for example, an episode in a medical examiner's office in Syracuse.17 Two prosec-