INFECTION CONTROL NEWSLETTER

November 1997
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@concentric.net

NOTICE: Federal OSHA has published a draft of the Tuberculosis Standard. The Standard is similar in structure to the Bloodborne Pathogens Standard. A copy can be obtained through the OSHA website at the OSHA websiteThe document is quite long and requires three seperate document download procedures.

Draft Guideline for Infection Control in Health Care Personnel, 1997

The Centers for Disease Control and Precention (CDC) published a draft guideline for infection control in health care presonnel of acute care hospitals. They are written for all health care personnel, but need to be modified to meet the needs of skilled nursing facilities. This brief article will address some of the conditions that effect employee health in this setting. Modifications to the CDC's recommendations will be noted. While the Guidelines are in draft form, they are expected to be finalized with few changes.

First, the guideline suggests that a all personnel have a health inventory which includes immunization history and any predisposing conditions which may put them at risk of infection (medications, dermatologic conditions, chronic diseases). They state that routine cultures for screening personnel should not be done. An initial tuberculosis skin test should be done and an optional blood screening for vaccine preventable diseases (hepatitis B, chickenpox, measles, mumps and rubella).

Restriction from work would be necessary for the following conditions:

Conjunctivitis
Diarrheal disease, acute stage
Diptheria
Hepatitis A
Herpes simplex on the hands
Measles
Mumps
Pertussis
Rubella
Scabies or pediculosis infestation
Active, draining skin lesions with Staphylococcus aureus
Group A Streptococcal infection
Tuberculosis
Varicella (chickenpox)
Viral respiratory illness with fever

The guideline also has a section on the pregnant health care worker. There are no special work restriction providing the worker follows the precaution guidelines set forth in the CDC's 1996 Isolation Guidelines. These include Standard Precautions plus Airborne, Contact and Droplet Precautions for specific conditions. Vaccination is stressed for those diseases that are vaccine preventable.

Finally, there is an extensive section on latex hypersensitivity. They suggest substituting nonlatex or powder-free laxtex gloves in areas where glove usage is high.

The guidelines can be found on the Internet at the Government Printing Office

Immunizations for Health Care Workers

Vaccination for health care workers is recommnded in the CDC's draft Guideline for Infection Control in Heathcare Personnel. This article will focus on the recommended immunizations for adults who are working in long term care facilities. Vaccines for Health Care Workers

Mumps, Measles and Rubella- if born after 1957, no prior vaccination and negative blood test
Varicella- no history of chickenpox and a negative blood test. (See discussion below)
Hepititis B- no prior vaccination and negative blood test
Influenza- give annually
Tetanus-diptheria- boosters given every 10 years

The importance of varicella vacination in skilled nursing facilities is under appreciated. Varicella (chickenpox) is caused by the same virus responsible for shingles (herpes zoster). Shingles among the residents is a common occurence and therefore presents a potential hazard to any non-immune health care worker. Chickenpox in adults carries a high rate of hospitalization and mortality. In addition, there is a risk to pregnant workers during their last trimester. If the mother develops chickenpox shortly before birth, the baby can become infected at the time of birth. Mortality rates for these infants is very high. Therefore, it is recommended to begin a varicella vaccination program. This can be accomplished by doing screening by questionnaire and a blood test for those with no history of chickenpox. Please contact us if you would like more information about a varicella prevention program in your facility.