1. IntroductionThe introduction to the guide describes why it serves as a resource to be used by those with the greatest responsibility of all -- protecting one of our most valuable assets, healthcare personnel. Practical Guide users may include professionals with job functions or tasks in occupational or employee health and safety, infection prevention and control, biological safety, infectious disease, risk management, biological safety, and/or environmental health and safety in healthcare settings. The guide is meant to serve those with varying levels of experience in occupational health and/or occupational infection prevention. The introduction provides high-level information on how the guide serves as both background and fundamental information to help readers gain confidence as they ramp up in their roles. It highlights the tools, resources, and ideas that are new and ready to roll out or pass along.
2. Public Health SignificanceThis chapter discusses in detail why occupational exposure to infectious diseases in health care is an important public health issue. Since there are hundreds of microorganisms that can cause illness or infection in humans (pathogenic organisms), this chapter describes the highest prevalence organisms that affect healthcare workers. It provides a list and discussion for what microorganisms are most likely to cause occupational illness or infection in the working population. It also exposes the reader to provocative information about the healthcare environment, and vectors including contaminated hands, patient care items (e.g., blood pressure cuffs, stethoscopes), medical devices (e.g., IV infusion connectors, endoscopes, surgical instruments), and contaminated surfaces or textiles (e.g., uniforms, lab coats, sinks, toilets, bedrails, etc.).
3. Controlling & Preventing Occupational Illness & InfectionThe chapter sets the stage for a grounding in the critical elements in an occupational infection prevention and control plan. It describes important employee vaccination and immunization plans. The concepts of the industrial hygiene hierarchy of controls are introduced. The hierarchy is an evidence-based method to help readers build, design, and evaluate preventive strategies that provide the highest and most productive levels of protection. It also provides information on workers' rights, whistleblowing, and personnel-based opportunities for change.
4. MicrobiologyChapter 4 provides a background on the most epidemiologically important microbes likely to be an occupational exposure risk -- serving as a Microbiology 101 for non-microbiologists. It can be incorporated into new employee onboarding or annual refresher training. It describes how microorganisms propagate and transmit and why some microorganisms cause disease (are pathogenic). It provides control strategies to mitigate exposure risk for personnel, leadership, and the communities they serve. It also highlights the critical elements of Post-Exposure Prophylaxis and Antimicrobial Stewardship Plans.
5. Regulatory Compliance; OSHA StandardsThere are surprisingly few regulatory standards or laws that apply to occupational infection prevention and control. The bulk of the standards are promulgated by the Occupational Safety and Health Administration (OSHA). This chapter provides in-depth information on the elements of OSHA Standards applicable to infectious disease in health care, including the Bloodborne Pathogens, Respiratory Protection, and Personal Protective Equipment Standards. It describes the essential components for compliance with OSHA standards and provides a foundation for complying with OSHA standards as it relates to inspections, citations, and fines. This chapter details how to comply and what resources to use for compliance assistance. It serves as the roadmap to professionals responsible for regulatory compliance on behalf of their employers.
6. Other Regulatory Requirements, National Standards, and AccreditationChapter 6 has comprehensive lists of other relevant Federal Agencies and Accreditation Bodies that provide requirements and recommendations for exposure to infectious disease beyond OSHA. These include the Department of Transportation, Environmental Protection Agency, the Joint Commission, and more. It describes, in detail, the essential components for compliance with standards and guidance and delivers tools, checklists, and program ideas for readers to use immediately. Since many different types of healthcare facilities (acute care, long-term care, behavioral health, outpatient, etc.) adhere to different licensing and accreditation bodies, it provides references and resources to set professionals on the right path.
7. Hazard AssessmentThe hazard assessment chapter offers readers strategies to identify critical elements needed to perform an occupational hazard assessment. It provides lists for considerations to include in job hazard analyses. There are many tools and resources including outlines and sample plans for requirements of an Exposure Control Plan. It also provides instruction and guidance on how to perform task assessments and audits, along with sample plans and questionnaires.
8. Institutional ControlsIn safety and health professions, we typically address safety controls in the context of what risk can be physically "engineered" out. In other words, how do we physically make a workplace safer? This chapter describes how individualized health beliefs can drive safer occupational outcomes. It provides readers with the confidence to be able to discuss the differences between Safety Culture & Safety Climate with leadership and personnel. It illustrates ways to identify cues to action for safe work practices. It also provides unique examples of opportunities to "teach up" to leadership and tools to establish strategies for communicating cost and value of programs.
9. Engineering ControlsIn Chapter 9, readers gain an understanding of how to identify the role of engineering controls in the industrial hygiene hierarchy of controls. Using the hierarchy provides readers with the ability to introduce the role that adjunct or adjuvant technologies can play in reducing environmental pathogens in their facilities. In addition, it summarizes resources to identify available engineering controls for safer options for medical devices, textiles, and antimicrobial technologies.
10. Personal Protective Equipment (PPE)This section provides a background on the position of PPE in the hierarchy of controls. Readers will be able to identify the role of PPE in health care and barriers to use. Since so much of health care has relied on this less desirable method of occupational prevention, the section builds knowledge around why considerations for protection that are higher in the hierarchy of controls may be more effective and appropriate. It describes standards and specifications for PPE and their application in health care and provides information on selection of each PPE type. This includes the provision of lists of tools and resources that can be put into action immediately.
11. Making It All WorkChapter 11 pulls everything together into a comprehensive summary resource. It summarizes key motivations for building safer occupational infection prevention programs and then provides the subsequent tools, resources, and checklists for professionals to move those programs forward. It includes sample cost-benefit analyses, lists of standards to consider for compliance, required precautions practices, and more.
13. Appendices (tools, charts, campaigns, etc.)This can be a stand-alone section with all subsequent tools, charts, checklists, campaign poster ideas, and more. Or it can be incorporated into each applicable section. Marketability may be in both places.
This book is a practical guide for preventing occupational exposures to bloodborne and infectious disease in health care. It is a timely and essential resource given that people working in healthcare settings sustain a higher incidence of occupational illness than any other industry sector, and at the time of publication of this book we are in the midst of a global pandemic of COVID-19. While the guide is focused on health care primarily, it would be useful for preventing exposures to essential workers in many other industries as well.
The guide offers easy-to-follow instruction, all in one place, for creating, implementing, and evaluating occupational health and safety programs. Readers have practical information that they can use now to either build a new program or expand an existing one that protects workers from occupationally associated illness and infection. With a focus on the public health significance of building better, safer programs in health care, the book provides not just the evidence-based or data-driven reasoning behind building successful programs, but also includes sample programs, plans, checklists, campaigns, and record-keeping and surveillance tools. Topics explored among the chapters include:
* Occupational Safety and Health Administration (OSHA) Regulatory Compliance * Other Regulatory Requirements, National Standards, and Accreditation * Performing a Hazard Assessment and Building an Exposure Control Plan * Engineering Controls and Safer Medical Devices * Personal Protective Equipment Placement and Use * Facing a Modern Pandemic
Preventing Occupational Exposures to Infectious Disease in Health Care is a comprehensive resource for both seasoned and novice professionals with primary, secondary, or ancillary responsibility for occupational or employee health and safety, infection prevention, risk management, or environmental health and safety in a variety of healthcare or patient care settings. It also would appeal to those working in public health, nursing, medical, or clinical technical trades with an interest in infection prevention and control and/or occupational health and infectious disease.
Amber Hogan Mitchell, DrPH, MPH, CPH, is president and executive director of the International Safety Center. The Center distributes the Exposure Prevention Information Network (or "EPINet") free to hospitals to measure occupational exposures to blood and body fluid and other potentially infectious materials that cause illness and infection in the working population. EPINet is the world's most widely used surveillance tool for this type of data.
Dr. Mitchell's career has been focused on public health and occupational safety and health related to infectious disease. She has worked in the public, private, and academic sectors. Dr. Mitchell began her career as the very first OSHA National Bloodborne Pathogens Coordinator as a Senior Industrial Hygienist and has received several Secretary of Labor Excellence awards for her work on healthcare worker safety as well as bioterrorism and public preparedness. She sat on a team of dedicated professionals that integrated the Needlestick Safety and Prevention Act into the regulatory landscape.
Dr. Mitchell has held regulatory and medical affairs positions for medical device companies. As a Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) doctoral scholar, she completed her Doctor of Public Health (DrPH) degree from the University of Texas School of Public Health. She holds a Bachelor's Degree in psychology from Binghamton University and a Master's in Public Health from The George Washington University. Dr. Mitchell is Certified in Public Health as an esteemed member of the very first CPH cohort offered by the National Board of Public Health Examiners. She was the 2019 Chair of the Occupational Health and Safety (OHS) Section of the American Public Health Association (APHA).
Dr. Mitchell continues to serve the country as a senior science advisor for the National Institute of Environmental Health Sciences (NIEHS) for Worker Training Program for COVID-19. She is also Adjunct Faculty at the University of Maryland School of Medicine, Department of Occupational and Environmental Medicine.