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Healthcare workers (HCWs) are occupationally exposed to a variety of infectious diseases during the performance of their duties. The delivery of healthcare services requires a broad range of workers, such as physicians, nurses, technicians, clinical laboratory workers, first responders, building maintenance, security and administrative personnel, social workers, food service, housekeeping, and mortuary personnel. Moreover, these workers can be found in a variety of workplace settings, including hospitals, nursing care facilities, outpatient clinics (e.g., medical and dental offices, and occupational health clinics), ambulatory care centers, and emergency response settings. The diversity among HCWs and their workplaces makes occupational exposure to infectious diseases especially challenging. For example, not all workers in the same healthcare facility, not all individuals with the same job title, and not all healthcare facilities will be at equal risk of occupational exposure to infectious agents.
The primary routes of infectious disease transmission in U.S. healthcare settings are contact, droplet, and airborne. Contact transmission can be sub-divided into direct and indirect contact. Direct contact transmission involves the transfer of infectious agents to a susceptible individual through physical contact with an infected individual (e.g., direct skin-to-skin contact). Indirect contact transmission occurs when infectious agents are transferred to a susceptible individual when the individual makes physical contact with contaminated items and surfaces (e.g., door knobs, patient-care instruments or equipment, bed rails, examination table). Two examples of contact transmissible infectious agents include Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococcus (VRE).
Droplets containing infectious agents are generated when an infected person coughs, sneezes, or talks, or during certain medical procedures, such as suctioning or endotracheal intubation. Transmission occurs when droplets generated in this way come into direct contact with the mucosal surfaces of the eyes, nose, or mouth of a susceptible individual. Droplets are too large to be airborne for long periods of time, and droplet transmission does not occur through the air over long distances. Two examples of droplet transmissible infectious agents are the influenza virus which causes the seasonal flu and Bordetella pertussis which causes pertussis (i.e., whooping cough).
Airborne transmission occurs through very small particles or droplet nuclei that contain infectious agents and can remain suspended in air for extended periods of time. When they are inhaled by a susceptible individual, they enter the respiratory tract and can cause infection. Since air currents can disperse these particles or droplet nuclei over long distances, airborne transmission does not require face-to-face contact with an infected individual. Airborne transmission only occurs with infectious agents that are capable of surviving and retaining infectivity for relatively long periods of time in airborne particles or droplet nuclei. Only a limited number of diseases are transmissible via the airborne route. Two examples of airborne transmissible agents include Mycobacterium tuberculosis which causes tuberculosis (TB) and the rubella virus which causes measles.
Several OSHA standards and directives are directly applicable to protecting workers against transmission of infectious agents. These include OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030) which provides protection of workers from exposures to blood and body fluids that may contain bloodborne infectious agents; OSHA's Personal Protective Equipment standard (29 CFR 1910.132) and Respiratory Protection standard (29 CFR 1910.134) which provide protection for workers when exposed to contact, droplet and airborne transmissible infectious agents; and OSHA's TB compliance directive which protects workers against exposure to TB through enforcement of existing applicable OSHA standards and the General Duty Clause of the OSH Act.
Below is an abbreviated list of CDC resources available to assist HCWs in assessing and reducing their risks for occupational exposure to infectious diseases.
- Hand Hygiene in Healthcare Settings. This web page provides HCWs and patients with a variety of resources including guidelines for providers, patient empowerment materials, the latest technological advances in hand hygiene adherence measurement, frequently asked questions, and links to promotional and educational tools published by the World Health Organization (WHO), universities, and health departments.
- Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. This document is a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings.
- Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. This document presents evidence-based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient-care medical devices and for cleaning and disinfecting the healthcare environment. This document supersedes the relevant sections contained in the 1985 Centers for Disease Control and Prevention (CDC) Guideline for Handwashing and Environmental Control.
- 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. This document is intended for use by infection control (IC) staff, healthcare epidemiologists, healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating IC programs for healthcare settings across the continuum of care.
- Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. All healthcare settings are affected by the emergence and transmission of antimicrobial-resistant microbes. These guidelines provide information for the prevention of transmission of Multidrug Resistant Organisms (MDROs).
- Guidelines for Environmental Infection Control in Health-Care Facilities. (June 6, 2003). This web page provides guidelines, recommendations and strategies for preventing environment-associated infections in healthcare facilities.
- Guideline for Infection Control in Health Care Personnel, 1998. These guidelines address infection control procedures to protect workers from occupational exposure to infectious agents.
- Healthcare Workers. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic. Healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers. Women represent nearly 80% of this work force. Healthcare workers face a wide range of hazards on the job, including needlestick injuries, back injuries, latex allergy, violence, and stress.
- Eye Safety – Eye Protection for Infection Control. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic. NIOSH recommends eye protection for a variety of potential exposure settings where workers may be at risk of acquiring infectious diseases via ocular exposure.
- Bloodborne Pathogens and Needlestick Injuries. OSHA Safety and Health Topics Page.
- Seasonal Flu. OSHA Safety and Health Topics Page.
- Pandemic Influenza. OSHA Safety and Health Topics Page.
- Methicillin-resistant Staphylococcus Aureus (MRSA) Infections. Centers for Disease Control and Prevention (CDC). Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics which include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. This web site has links to numerous other web sites that provide information for protection of healthcare workers from MRSA infections.
- MDRO - Multidrug-Resistant Organisms – MRSA. OSHA. This is the Methicillin-resistant Staphylococcus aureus (MRSA) portion of the multi-drug resistant organism module of OSHA's Hospital eTool. This electronic aid provides information (see Disclaimer) to help stop the spread of MRSA among employees and others working in healthcare and other industries. Your local public health agency has information on what your community is doing to prevent the spread of MRSA.
- A Norovirus Outbreak Control Resource Toolkit for Healthcare Settings. Centers for Disease Control and Prevention (CDC). Because of high levels of contact and vulnerable patient populations, healthcare settings can be particularly susceptible to outbreaks of norovirus. To help address the challenges of managing and controlling norovirus gastroenteritis outbreaks in healthcare settings, the CDC offers a toolkit for healthcare professionals including up-to-date information, recommended infection control measures, and tools for outbreak response coordination and reporting.
- Noroviruses. (May 2008). OSHA Fact Sheet. Although noroviruses are currently more of a concern to the general public than to workers, the increasing incidence of norovirus outbreaks exposes many different worker groups, especially healthcare workers (HCWs).
- Tuberculosis. OSHA Safety and Health Topics Page.
Additional Biological Agents
- Biological Agents. OSHA Safety and Health Topics Page.
- California Code of Regulations, Title 8, Section 5199. Aerosol Transmissible Diseases. Cal-OSHA's ATD standard protects laboratory workers, as well as, healthcare workers, emergency responders, and many others from exposure to droplet and airborne transmissible diseases when engaged in the performance of their duties.