Volume: 28S1 • March 2002

Infection Control Guidelines

Prevention and Control of Occupational Infections in Health Care

Division of Nosocomial and Occupational Infections
Bureau of Infectious Diseases
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
Health Canada

Prevention and Control of Occupational Infections in Health Care
276 Pages - 1,757 KB in PDF Format

 Introductory Statement | Executive Summary | Table of Contents

 Introductory Statement

The primary objective in developing clinical guidelines at the national level is to help health care professionals improve the quality of health care. Guidelines for the control of infection are needed to assist in developing policies, procedures, and evaluative mechanisms to ensure an optimal level of care. Guidelines, by definition, are directing principles and indications or outlines of policy or conduct that should not be regarded as rigid standards. Guidelines facilitate the setting of standards but respect the autonomy of each health care setting and recognize the governing body's authority and responsibility to ensure the quality of care provided. Personnel in health care settings should also be aware of the regulations and policies in their local and provincial/territorial area regarding infectious diseases.

The Health Canada Infection Control Guidelines have been based, whenever possible, on research findings. Sometimes published research is insufficient, and the consensus of experts in the field has therefore been used to provide guidelines specific to conventional practice¹. The information in these guidelines was current at the time of publication; it should be emphasized that areas of knowledge and aspects of medical technology advance with time. Both encouragement of research and frequent revision and updating to keep pace with advances in the field are necessary if guidelines are to achieve the purpose for which they were developed.

The Steering Committee acknowledges, with sincere appreciation, the many practising health professionals and others who contributed advice and information to this endeavour. Health Canada is especially appreciative of the time and expertise contributed by the Subcommittee for the Prevention and Control of Occupational Infections in Health Care, which worked diligently and successfully to develop these extensive guidelines.

The guidelines outlined below are part of the Health Canada Infection Control Guidelines series that has been developed over a period of years under the guidance of the Infection Control Steering Committee. Prevention and Control of Occupational Infections in Health Care replaces Occupational Health in Health Care Facilities (1990). The new guideline presents an overview and provides recommendations to assist in the prevention and management of health care worker exposures and infections in health care. It is intended to be used with the other Infection Control Guidelines² and relevant Health Canada documents that are published in the Canada Communicable Disease Report. These include the following:

• Essential Resources for Infection Control Effectiveness (in preparation)⁽¹⁾
• Creutzfeldt-Jakob Disease (CJD) in Canada (in preparation)⁽²⁾
• Construction-related Nosocomial Infections for Patients in Health Care Facilities: Decreasing the Risk of Aspergillus, Legionella and other Infections (2001)⁽³⁾
• Routine Practices and Additional Precautions for Preventing Transmission of Infection in Health Care (1999)⁽⁴⁾
• Infection Prevention and Control Practices for Personal Services: Tattooing, Ear/Body Piercing, and Electrolysis (1999)⁽⁵⁾
• Hepatitis C - Prevention and Control: A Public Health Consensus (1999)⁽⁶⁾
• Proceedings of the National Varicella Consensus Conference (1999)⁽⁷⁾
• Canadian Immunization Guide, 5th edition (1998)⁽⁸⁾
• Proceedings of the Consensus Conference on Infected Health Care Workers: Risk of Transmission of Bloodborne Pathogens (1998)⁽⁹⁾
• Hand Washing, Cleaning, Disinfection and Sterilization in Health Care (1998)⁽¹⁰⁾
• Preventing the Transmission of Bloodborne Pathogens in Health Care and Public Services Settings (1997)⁽¹¹⁾
• An Integrated Protocol to Manage Health Care Workers Exposed to Bloodborne Pathogens (1997)⁽¹²⁾
• Canadian Contingency Plan for Viral Hemorrhagic Fevers and Other Related Diseases (1997), produced by the Office of Special Health Initiatives⁽¹³⁾
• Preventing the Spread of Vancomycin-Resistant Enterococci (VRE) in Canada (1997)⁽¹⁴⁾
• Foot Care by Health Care Providers (1997)⁽¹⁵⁾
• Preventing Infections Associated with Indwelling Intravascular Access Devices (1997)⁽¹⁶⁾
• Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings (1996)⁽¹⁷⁾
• Laboratory Biosafety Guidelines. 2nd edition (1996), produced by the Office of Biosafety⁽¹⁸⁾
• A National Consensus on Guidelines for Establishment of a Post-Exposure Notification Protocol for Emergency Responders (1995)⁽¹⁹⁾
• National Symposium on Risk and Prevention of Infectious Diseases for Emergency Response Personnel (1994)⁽²⁰⁾
• Long Term Care Facilities (1994)⁽²¹⁾
• Organization of Infection Control Programs in Health Care Facilities (1990)⁽²²⁾

For information regarding the above Health Canada publications, contact:

Division of Nosocomial and Occupational Infections
Bureau of Infectious Diseases
Centre for Infectious Disease Prevention and Control
Health Canada, PL 0603E1
Ottawa, Ontario K1A 0L2
Telephone: (613) 952-9875
Fax: (613) 998-6413

Web site URL:
<http://www.phac-aspc.gc.ca/dpg_e.html#infection>

¹ See Appendix I: Guideline Evidence-Based Rating System

² For an ongoing update of the Infection Control Guidelines series, please view the Health Canada Web site at http://www.phac-aspc.gc.ca/dpg_e.html#infection.

Executive Summary

The Guideline for the Prevention and Control of Occupational Infections in Health Care (2002), is one in the series of Infection Control Guidelines for health care personnel prepared by Health Canada's Division of Nosocomial and Occupational Infections. It is designed to assist occupational health (OH) practitioners, medical directors and others responsible for infectious diseases that affect health care workers (HCWs). This guideline is primarily intended for hospitals and long-term care facilities and may be useful for home care and community health workers, contract services, daycare or correctional service workers. This Guideline makes frequent reference to a companion Guideline, Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care. This companion Guideline provides a comprehensive list of infectious diseases and precautions necessary to prevent transmission when providing patient care.

This Guideline presents an overview of occupational infections in health care and provides recommendations to assist in the prevention and management of HCWs' exposures to, and infections with, infectious diseases. It updates and replaces recommendations from the previous document, Occupational Health in Health Care Facilities (1990) by reflecting the four principles of OH programs (risk assessment, risk control measures, education, and evaluation).

Recommendations are based on the most current literature and the consensus of the Working Committee for Prevention and Control of Occupational Infection in Health Care. Since literature is frequently updated and public health legislation supercedes these recommendations, the user should also consult new information and local public health officials to ensure the recommendations' applicability to local practices. This guideline:

1) supports the essential collaboration between OH programs and Infection Control programs;

2) focuses on infectious diseases for which there is evidence that person-to-person transmission has occurred through occupational exposure;

3) addresses occupational infections that may occur during the delivery of health care.

Section A. " Recommendations for Infection Prevention and Control Components of an Occupational Health Program" outlines the foundations of an effective OH program with particular focus on prevention, health promotion, and reduction of health hazards in health care settings. Major attention is given to the assessment of infectious disease hazards.

Section B. "Recommendations for Diseases of Significance to Occupational Health" augments the general risk assessment of Section A with disease specific analyses. Risk Control Measures provides recommendations for HCWs who are symptomatic, colonized, or infected with a communicable disease, independent of an occupational exposure. To assist the user to identify a true exposure or infection in order to clarify management, Criteria to Confirm the Diagnosis have been provided with each disease.

When applicable, disease specific recommendations are made. Cited evidence is based on literature pertinent to health care and more specifically to the HCW. General recommendations for prophylaxis and treatment are current at the time of publication. Because of the rapid changes in drug regimens, specific medication recommendations have not been made and the user is referred to current literature.

Both sections A and B contain recommendations for actions by the individuals who have responsibility for OH programs, i.e., OH or administration. Statements regarding essential infrastructure and resources for the program are clearly identified.

An algorithm (see page 6) " Occupational Health Management Strategy for Infectious Diseases in HCWs" clarifies the roles and responsibilities of OH, Administration and the HCW for the user and outlines the path for management of infection-related issues.

Section C. "Health Care Worker Immunization and Recommendations" adapts information from Health Canada's Canadian Immunization Guide and published recommendations from the National Advisory Committee on Immunization (NACI) about vaccine-preventable diseases pertinent to OH in health care settings. Maintenance of immunity against vaccine-preventable diseases is identified as an integral part of an OH program.

Section D. The "Summary Table" is a quick reference of the disease-specific information presented in Section B. The Table includes exposure definitions and identifies prophylaxis, treatment and/or work restrictions.

Appendix I. The "Guideline Evidence-Based Rating System" describes the system of ranking the strength of the evidence that exists with respect to recommendations made in the guideline.

Appendix II. The "Literature Review of Bloodborne Pathogen Exposures to Health Care Workers and their Control Measures" describes the incidence of sharp, mucocutaneous and bite exposures among HCWs that puts them at risk for acquiring bloodborne pathogens in addition to the effectiveness of control measures.

Appendix III. The "Canadian Needle Stick Surveillance System (CNSSN)" outlines the surveillance protocol, results of the analysis of one year's data and future plans of the CNSSN.

The Health Canada guidelines are available for all those involved in preventing transmission of infection in today's changing health care environment. They are available on the Public Health Agency of Canada web site (www.phac-aspc.gc.ca/ publicat/ccdr-rmtc/). Printed copies are available from the Canadian Medical Association at 1-888-855-2555. For further information, please contact the Division of Nosocomial and Occupational Infections at 613-952-9875.

Table of Contents

Prevention and Control of Occupational Infections in Health Care
276 Pages - 1,757 KB in PDF Format