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Infectious Diseases

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Healthcare workers (HCWs) may be exposed to a variety of infectious diseases during the performance of their duties. The delivery of healthcare services requires a broad range of workers and includes those who:

  • Perform triage and administrative duties;
  • Provide direct patient care (at any location);
  • Collect, test, and analyze biological specimens;
  • Provide emergency response and transportation;
  • Clean and maintain patient rooms;
  • Prepare and deliver food;
  • Perform death care (mortuary) services.

Moreover, these workers can be found in a variety of workplace settings, such as:

  • Hospitals;
  • Long-term care facilities;
  • Outpatient clinics (e.g., medical and dental offices, and occupational health clinics);
  • Emergency response settings;
  • Domestic caregiving settings.

HCWs perform a diversity of work duties in a variety of settings, but those who have direct and prolonged contact with patients who are ill from infectious diseases are at the highest risk of exposure.

For more information about Infectious Diseases see OSHA's Safety and Health Topics Page.

The primary routes of infectious disease transmission in U.S. healthcare settings are by contact and through the air.

Contact transmission

Contact transmission can be sub-divided into direct and indirect contact. Nearly all pathogens can spread by contact, and this is an important and frequent mode of transmission.

Direct contact transmission involves the transfer of infectious agents to a susceptible person by direct skin-to-skin contact with an infected person or through contact with splashes or sprays with infectious body fluids. In addition, direct contact includes transfer of pathogens in the blood of an infected person to the blood of a susceptible person via needlestick.

Indirect contact transmission occurs when infectious agents are transferred from contaminated items and surfaces (e.g., doorknobs, patient-care instruments or equipment, bed rails, examination tables, etc.) to a susceptible person. Although many pathogens do not survive for long periods outside of the body, some bacteria can live for months on inanimate objects, which emphasizes the importance of cleaning and disinfection in healthcare settings.

Transmission through the air

Droplet Transmission. Direct deposition of infectious respiratory particles (IRP) in droplets are expelled when an infected person coughs, sneezes, sings, or talks. The droplets travel a short distance and “land” on mucosal surfaces of the eyes, nose, or mouth of a susceptible person, then enter the respiratory system, causing infection. These IRP droplets may spread several meters/yards but are too large to remain airborne for long periods of time.

Airborne transmission occurs when IRP that are expelled when an infected person coughs, sneezes, or talks, remain suspended in air and are inhaled by a susceptible person, entering the respiratory tract, leading to infection. These IRP are in relatively tiny droplets and can remain suspended in the air for extended periods of time. Air currents can spread them over long distances, so airborne transmission of IRP does not require face-to-face contact with an infected person. Two examples of agents that can be spread via airborne transmission include Mycobacterium tuberculosis which causes tuberculosis (TB) and the measles virus (Morbillivirus hominis), which causes measles.

Note that in healthcare settings, transmission through the air can occur during certain medical procedures, such as suctioning or endotracheal intubation, so appropriate measures must be taken to prevent exposure.

Infection Prevention and Control

The CDC describes conditions that can increase the risk of exposure to infectious organisms and provides tools and resources for HCW to help lower the risk of infection. OSHAs Bloodborne Pathogen and Needlestick Prevention provides Important information about Evaluating and Controlling Exposure to Bloodborne Pathogens that includes links to websites about safer needle devices and decontamination agents, some of which can be applied to methods of preventing exposure to many types of pathogens. Healthcare-associated infections are often preventable when appropriate infection prevention and control (IPC) measures are implemented.

Several OSHA standards and directives are aligned with IPC and are directly applicable to protecting U. S. workers against transmission of infectious agents. These include OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030) that requires employers to protect 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) that requires employers to protect workers that may be exposed to transmissible infectious agents; and OSHA's TB compliance directive which is designed to protect workers against TB exposure through enforcement of existing applicable OSHA standards and the General Duty Clause of the OSH Act.

Some states have implemented laws to protect workers from infectious diseases. For example, healthcare facility operators in the State of California are subject to the California Code of Regulations, Title 8, Section 5199. Aerosol Transmissible Diseases that are intended to protect HCW from exposure to infections that are spread through the air. New York state has implemented NYS Labor Law Section 218-b, "Prevention of occupational exposure to an airborne infectious disease" which requires all private sector employers to develop Airborne Infectious Disease Exposure Prevention Plans for future designated disease outbreaks.

Additional Resources