At a glance
Research methods for the Infection Control in Healthcare Personnel (2023), from the Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services guideline (2019).
Overview
This document is an update of four sections of Part I of the Guideline for infection control in health care personnel, 1998, and their corresponding recommendations in Part II:
- C. Infection Control Objectives for a Personnel Health Service;
- D. Elements of a Personnel Health Service for Infection Control;
- H. Emergency-Response Personnel; and
- J. The Americans With Disabilities Act.
The sections were updated by experts in occupational health, infectious diseases, and infection prevention and control (IPC). Updates were informed by a systematic review of recent articles published in peer-reviewed journals and databases of systematic reviews, guidelines, and regulations. All updates were vetted at public meetings of the Healthcare Infection Control Practices Advisory Committee (HICPAC) (See Appendix 1. Contributors).
Literature Search Questions
The questions developed to guide the literature search were:
- What service elements are important for occupational health services that aim to prevent transmission of infections among healthcare personnel and patients in the United States?
- What is known about implementing or delivering the following eight infection prevention and control elements of an occupational health service in the United States?
- Leadership and management
- Communication and collaboration
- Assessment and reduction of risks for infection among healthcare personnel populations
- Medical evaluations
- Occupational infection prevention and control education and training programs
- Immunization programs
- Management of potentially infectious exposures and illnesses
- Management of healthcare personnel health records
- What interventions can improve the delivery or quality of one of the eight elements, or reduce transmission of infections among healthcare personnel and patients in the United States?
Literature Search
The infrastructure and delivery of healthcare to patients, and hence the provision of occupational IPC services to healthcare personnel (HCP), have changed since the publication of the Guideline for infection control in health care personnel, 1998. CDC conducted a targeted literature search for recent articles consistent with current approaches in occupational IPC service delivery to HCP. Search strategies were formulated using a combination of Medical Subject Headings (MeSH) terms and key words to identify literature that focused on at least one of the eight OHS IPC elements. Four searches were performed in MEDLINE, EMBASE, and CINAHL, or the Cochrane Database of Systematic reviews.
Searches sought:
- Articles published from January 2004 – October 2015 that were indexed in one of three databases (Table A3.1).
- Articles published from January 2004 – December 2015 that were indexed in one of three databases using different key words (Table A3.2).
- Meta-analyses and systematic reviews published from January 2004 – December 2015 that were indexed in the Cochrane Database of Systematic Reviews (Table A3.3).
- Meta-analyses, systematic reviews, and narrative reviews about interventions to increase vaccination coverage among HCP published from January 2004–December 2015 that were indexed in one of three databases (Table A3.4).
In addition to the results of the systematic review, CDC (KI, DK) searched relevant websites and systematic review repositories of government agencies and nongovernmental organizations (Table A3.5) for additional guidelines, regulations, program evaluations, quality improvement initiatives, and systematic reviews.
Article Selection
CDC (MD, KI, DK, AO, KR, DT) conducted the title and abstract screening and the full text review using the below inclusion and exclusion criteria.
Inclusion Criteria: Articles were retrieved if they were:
- research studies, systematic and narrative reviews, meta-analyses, and other reports;
- relevant to an occupational health service element of interest; and
- relevant to prevention of transmission of infections among HCP or between HCP and patients.
Exclusion Criteria: Articles were excluded if they were:
- conference abstracts or unpublished academic dissertations;
- reports of OHS programs not related to HCP or related to dental practices, laboratory personnel, morgues, mortuaries, or in settings where healthcare is not provided; or
- non-U.S.-based studies (except for systematic or narrative reviews on immunization programs).
Figure A3.1 depicts the process of screening and selecting articles. Very few relevant intervention studies were found in indexed databases, and many lacked well-defined interventions, a comparison group, large study size, or longitudinal follow-up.
Recommendation Formulation
The authors formulated recommendations based on current federal regulations, standards, and recommendations, or informed by:
- guidance of nongovernmental organizations;
- qualitative assessment of findings about interventions, service delivery, or quality from the indexed and non-indexed sources reviewed; and
- professional experience and opinions regarding:
- the benefits, harms, feasibility, and acceptability of interventions to HCO leaders, administrators, OHS staff, and HCP; and
- the feasibility and applicability of interventions for diverse types of HCP and for varied service delivery models (e.g., provided on-site vs. off-site).
Authors recused themselves from decisions pertaining to the development of recommendations when there was a perceived or actual conflict of interest. HICPAC classified all recommendations as good practice statements based on professional experience and scientific evidence that indicated a high probability that the recommended action would do more good than harm1.
Reviewing and Finalizing the Guideline
Drafts of the updated sections and recommendations were presented at public HICPAC meetings in March 2016, July 2016, and December 2016. Input from HICPAC and the public were incorporated into subsequent drafts. The draft recommendations and narrative were provisionally approved by HICPAC at the December 2016 meeting2. Following further revisions, CDC then submitted the guideline to CDC clearance and subsequent posting to Regulations.gov for public comment. The comments were compiled and reviewed with a revised draft document at the May 2019 HICPAC meeting. The document was approved by HICPAC on May 17, 2019.
Table A3.1 First Search Strategy for Indexed Articles Published January 2004-October 2015, by Database
Search | Term | MEDLINE | EMBASE | CINAHL |
---|---|---|---|---|
1 | Healthcare Personnel | 949 | 1,162 | 479 |
2 | Health Care Personnel | 1,976 | 110,486 | 975 |
3 | Healthcare Worker | 808 | 1,002 | 2,944 |
4 | Health Care Worker | 1,085 | 1,323 | 4,526 |
5 | exp Health Personnel/ or exp Personnel, Hospital/ | 396,129 | 952,375 | – |
6 | 1 or 2 or 3 or 4 or 5 | 399,062 | 954,578 | 8,664 |
7 | occupational health | 44,941 | 43,405 | 26,378 |
8 | personnel health | 83 | 79 | 50,840 |
9 | occupational health objectives | 2 | 2 | 74 |
10 | 7 or 8 or 9 | 45,021 | 43,476 | 75,197 |
11 | 6 and 10 | 6,040 | 9,015 | 4,397 |
12 | preventive services | 3,984 | 4,319 | 2,496 |
13 | infection prevention | 2,639 | 45,325 | 37,752 |
14 | infection control | 32,631 | 73,945 | 51,187 |
15 | 12 or 13 or 14 | 38,149 | 116,256 | 54,673 |
16 | administration | 1,005,772 | 1,239,293 | 280,074 |
17 | coordination | 77,795 | 83,464 | 6,986 |
18 | 16 or 17 | 1,080,888 | 1,319,751 | 286,157 |
19 | 6 and 10 and 18 | 575 | 359 | 658 |
20 | medical evaluations | 352 | 380 | 4,282 |
21 | screening | 429,687 | 654,641 | 69,955 |
22 | surveillance | 160,830 | 179,458 | 25,725 |
23 | laboratory tests | 21,496 | 27,701 | 3,715 |
24 | immuni*ation | 137,580 | 120,244 | 17,972 |
25 | vaccination | 128,709 | 144,566 | 10,255 |
26 | exp medical history taking/ | 19,050 | 179,580 | 89 |
27 | 20 or 21 or 22 or 23 or 24 or 25 or 26 | 830,485 | 1,204,613 | 120,859 |
28 | 6 and 10 and 27 | 621 | 1,060 | 1,031 |
29 | staff education | 1,188 | 1,840 | 4,795 |
30 | exp inservice training/ | 25,343 | 11,054 | 76 |
31 | 29 or 30 | 26,365 | 12,818 | 4,869 |
32 | 6 and 15 and 31 | 298 | 257 | 26 |
33 | immuni*ation program | 1,625 | 1,700 | 3,560 |
34 | vaccination program | 2,303 | 2,642 | 982 |
35 | immuni*ation policy | 288 | 295 | 157 |
36 | vaccination policy | 618 | 665 | 238 |
37 | 33 or 34 or 35 or 36 | 4,609 | 5,037 | 4,417 |
38 | 6 and 37 | 344 | 644 | 265 |
39 | postexposure management | 55 | 60 | 37 |
40 | occupational counseling | 13 | 13 | 30 |
41 | infection counseling | 20 | 17 | 84 |
42 | health counseling | 496 | 519 | 1,100 |
43 | disease exposure management | 2 | 1 | 8 |
44 | occupational exposure management | 10 | 9 | 59 |
45 | counseling services | 819 | 856 | 834 |
46 | 39 or 40 or 41 or 42 or 43 or 44 or 45 | 1,384 | 1,445 | 1,980 |
47 | 6 and 46 | 153 | 400 | 56 |
48 | employee health records | 22 | 16 | 30 |
49 | employee medical records | 9 | 5 | 23 |
50 | 48 or 49 | 31 | 21 | 52 |
51 | 6 and 50 | 18 | 14 | 8 |
52 | 11 or 19 or 28 or 32 or 38 or 47 or 51 | 6,764 | 10,251 | 4,474 |
53 | limit to 2014 to present | 292 | 760 | 487 |
54 | limit to english | 266 | 718 | 480 |
55 | limit to humans | 250 | 709 | 273 |
56 | Exclude MEDLINE | – | 84 | – |
CINAHL | USA Only | – | – | 177 |
Table A3.2 Second Search Strategy for Indexed Articles Published January 2004-December 2015, by Database
Search | Term | MEDLINE | EMBASE | CINAHL |
---|---|---|---|---|
1 | Healthcare Personnel | 916 | 1,177 | 449 |
2 | Health Care Personnel | 1,964 | 112,789 | 966 |
3 | Healthcare Worker | 712 | 1,028 | 2,913 |
4 | Health Care Worker | 1,081 | 1,344 | 4,498 |
5 | exp Health Personnel/ or exp Personnel, Hospital/ | 410,717 | 972,375 | – |
6 | 1 or 2 or 3 or 4 or 5 | 413,621 | 974,604 | 8,592 |
7 | employee health | 999 | 958 | 2,175 |
8 | 6 and 7 | 213 | 256 | 125 |
9 | preventive services | 3,941 | 4,364 | 2,470 |
10 | infection prevention | 2,607 | 45,757 | 37,934 |
11 | infection control | 30,986 | 74,936 | 51,389 |
12 | 9 or 10 or 11 | 36,452 | 117,631 | 54,825 |
13 | administration | 999,337 | 1,250,816 | 280,408 |
14 | coordination | 78,129 | 84,331 | 6,868 |
15 | 13 or 14 | 1,074,822 | 1,332,098 | 286,382 |
16 | 6 and 8 and 15 | 32 | 24 | 26 |
17 | medical assessment | 1,083 | 31,221 | 1,998 |
18 | 6 and 8 and 17 | 0 | 1 | 2 |
19 | employee education | 86 | 69 | 210 |
20 | 6 and 12 and 19 | 3 | 6 | 4 |
21 | exposure management | 114 | 149 | 326 |
22 | communicable disease exposure management | 1 | 1 | 2 |
23 | 21 or 22 | 114 | 149 | 326 |
24 | 6 and 23 | 41 | 66 | 26 |
25 | healthcare hazard | 3 | 4 | 58 |
26 | health care hazard | 4 | 3 | 111 |
27 | infection control hazard | 3 | 4 | 16 |
28 | 25 or 26 or 27 | 10 | 11 | 183 |
29 | 8 or 16 or 18 or 20 or 24 or 28 | 266 | 338 | 354 |
30 | limit to 2004 to present | 109 | 211 | 222 |
31 | limit to english | 100 | 204 | 213 |
32 | limit to humans | 99 | 186 | 118 |
33 | Exclude MEDLINE | – | 13 | – |
CINAHL | USA Only | – | – | 67 |
Table A3.3 Third Search Strategy for Articles Published January 2004-December 2015 that were Indexed in Cochrane Database of Systematic Reviews
Search | Term | Results |
---|---|---|
1 | “infection control”:ti,ab,kw in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 82 |
2 | Infection Prevention:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 424 |
3 | “health care worker”:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 100 |
4 | Health Care Personnel:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 162 |
5 | Healthcare Worker:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 62 |
6 | Healthcare Personnel:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 75 |
7 | # 1 or #2 | 488 |
8 | #3 or #4 or #5 or #6 | 284 |
9 | #7 and #8 | 14 |
10 | “occupational health”:ti,ab,kw Publication Year from 2004 to 2015, in Cochrane Reviews (Reviews and Protocols) and Other Reviews (Word variations have been searched) | 148 |
12 | #8 and #10 | 19 |
13 | Vaccination | 185 |
14 | Immunization | 112 |
15 | #13 or #14 | 251 |
16 | #8 and #15 | 20 |
Table A3.4 Fourth Search Strategy for Indexed Articles about Immunization Programs for Healthcare Personnel Published January 2004-December 2015, by Database
Search | Term | MEDLINE | EMBASE | CINAHL |
---|---|---|---|---|
1 | Healthcare Personnel | 916 | 1,177 | 449 |
2 | Health Care Personnel | 1,964 | 112,789 | 966 |
3 | Healthcare Worker | 712 | 1,030 | 2,914 |
4 | Health Care Worker | 1,081 | 1,345 | 4,498/td> |
5 | exp Health Personnel/ or exp Personnel, Hospital/ | 410,717 | 974,452 | – |
6 | 1 or 2 or 3 or 4 or 5 | 413,623 | 976,685 | 8,593 |
7 | immuni*ation | 136,878 | 121,011 | 17,990 |
8 | vaccination | 130,963 | 146,145 | 10,179 |
9 | 7 or 8 | 229,682 | 226,581 | 22,537 |
10 | 6 and 9 | 4,657 | 14,067 | 865 |
11 | occupational health | 45,354 | 43,292 | 26,379 |
12 | employee health | 999 | 959 | 2,175 |
13 | personnel health | 81 | 79 | 3,402 |
14 | 11 or 12 or 13 | 45,922 | 43,960 | 30,919 |
15 | 6 and 9 and 14 | 308 | 489 | 182 |
16 | limit 15 to (meta analysis or “review”) | 24 | 72 | 10 |
17 | limit to 2004 to 2015 | 16 | 50 | 7 |
18 | limit to english | 13 | 46 | 7 |
19 | limit to humans | 13 | 45 | – |
20 | Exclude MEDLINE | – | 6 | – |
CINAHL | USA Only | – | – | 6 |
Table A3.5 Websites Examined for Government Regulations, Standards, Guidelines, and Other Reports about Occupational Infection Prevention and Control among Healthcare Personnel
Agency for Healthcare Research and Quality (AHRQ)
Centers for Disease Control and Prevention (CDC)
- Bernstein AB Health care in America: Trends in utilization[PDF – 135 pages], Hyattsville, Maryland: National Center for Health Statistics 2003
- Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th Edition
- Viral Hepatitis Hepatitis B Questions and Answers for Health Professionals
- Viral Hepatitis Hepatitis C Questions and Answers for Health Professionals
- Notes on the Interim US Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure
- Advisory Committee on Immunization Practices (ACIP)
- Vaccine Recommendations and Guidelines of the ACIP
- Vaccine Storage and Handling Toolkit
- Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in US Hospitals, Including Procedures for Donning and Doffing PPE
- National Healthcare Safety Network (NHSN)
- National Healthcare Safety Network (NHSN) CMS Requirements
- National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls
- National Notifiable Diseases Surveillance System (NNDSS)
- National Surveillance System for Healthcare Workers (NaSH) Summary report for blood and body fluid exposure data collected from participating healthcare facilities (June 1995 through December 2007)[PDF – 27 pages]
- Healthcare Infection Control Practices Advisory Committee
- Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)
- The Community Guide Interventions to Promote Seasonal Influenza Vaccinations Using Interventions with On-site, Free, Actively Promoted Vaccinations among Healthcare Workers 2008
Centers for Medicare & Medicaid Services (CMS)
- Conditions for Coverage (CfCs) and Conditions of Participations (CoPs)
- State Operations Manual, Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals[PDF – 546 pages]
- 42 CFR Parts 410, 411, 416 et al Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self- Referral; and Patient Notification Requirements in Provider Agreements; Final Rule[PDF – 464 pages] Fed Regist 2011;76(230)
Occupational Safety and Health Administration (OSHA)
- Hazard Identification Training Tool
- Hospital eTool: Administration
- eTools, eMatrix, Expert Advisors and v-Tools
- OSHA Forms for Recording Work-Related Injuries and Illnesses[PDF – 12 pages]
- Table of Contents/Authority for 1904 PART 1904 — Recording and Reporting Occupational Injuries and Illnesses
- Respiratory Protection (standard no1910134)
- Respiratory Protection (standard no 1910132) General Requirements
- Hazard Communication (standard no 19101200) Toxic and Hazardous Substances Occupational Safety and Health Standards
- Bloodborne pathogens (standard no 19101030) Toxic and Hazardous Substances Occupational Safety and Health Standards
- Access to employee exposure and medical records (standard 19101020) Toxic and Hazardous Substances Occupational Safety and Health Standards
US Congress
- Public Law 104–191, Health Insurance Portability and Accountability Act of 1996 104th Congress[PDF – 169 pages]
- Public Law 111-87, Ryan White HIV/AIDS Treatment Extension Act of 2009 111th Congress[PDF – 19 pages]
US Department of Justice (DOJ)
- Information and Technical Assistance on the Americans with Disabilities Act
- Americans with Disabilities Act Compliance
US Department of Labor (DoL)
- Family and Medical Leave Act Wage and Hour Division
US Food and Drug Administration (FDA)
- US Food and Drug Administration
- MedWatch: The FDA Safety Information and Adverse Event Reporting Program
Private Organizations/ Professional Societies
- American College of Occupational and Environmental Medicine (ACOEM)
- American Society for Healthcare Engineering (ASHE)
- Association for Professionals in Infection Control and Epidemiology (APIC)
- Council of State and Territorial Epidemiologists (CSTE)
- Infectious Diseases Society of America (IDSA)
- IDSA and the American Association for the Study of Liver Diseases (AASLD) HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C
- National Quality Forum (NQF)
- NQF National Voluntary Consensus Standards for Influenza and Pneumococcal Immunizations
- Society for Healthcare Epidemiology of America (SHEA)
- Standard IC020401 Influenza Vaccination for Licensed Independent Practitioners and Staff (HAP, CAH, LTC) The Joint Commission December 2, 2011
- Joint Commission on Accreditation of Healthcare Organizations, New infection control requirement for offering influenza vaccination to staff and licensed independent practitioners, Joint Commission Perspectives, 26 (2006) 10-11[PDF – 2 pages] The Joint Commission
- Clinician Consultation Center University of California, San Francisco
International Sources
- Public Health Agency of Canada Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada Office of Nursing Policy
- Public Health Agency of Canada Healthcare Acquired Infections Infection Control Guideline Series
- Scottish Intercollegiate Guidelines Network (SIGN)
- Guyatt G, Schunemann HJ, Djulbegovic B, et al. Guideline panels should not GRADE good practice statements (https://www.sciencedirect.com/science/article/pii/S0895435614005447?via%3Dihub). J Clin Epidemiol. 2015;68: 597-600. Accessed August 20, 2019.
- Record of the Proceedings, Healthcare Infection Control Practices Advisory Committee, December 1-2, 2016 [PDF – 139 pages] (https://www.cdc.gov/hicpac/pdf/archive/2016December-HICPAC-meeting.pdf). Centers for Disease Control and Prevention. Accessed August 20, 2019.