Chapter 125. Health Care– Associated Infections (Part 11) Employee Health Service Issues An institution's employee health service is a critical component of its infection-control efforts. New employees should be processed through the service, where a contagious-disease history can be taken; evidence of immunity to a variety of diseases, such as hepatitis B, chickenpox, measles, mumps, and rubella, can be sought; immunizations for hepatitis B, measles, mumps, rubella, and varicella can be given as needed and a reminder about the need for yearly influenza immunization can be imparted; baseline and "booster" PPD (purified protein derivative of tuberculin) skin-testing or serologic testing for tuberculosis can be performed; and education about personal responsibility for infection control can be initiated. Evaluations of employees should be codified to meet the requirements of accrediting and regulatory agencies. The employee health service must have protocols for dealing with workers who have been exposed to contagious diseases, such as those percutaneously or mucosally exposed to the blood of patients infected with HIV or hepatitis B or C virus. For example, postexposure HIV prophylaxis with a combination of two or three antiretroviral agents is recommended; free consultation is available from the CDC PEPLine (888-HIV-4911). Protocols are also needed for dealing with caregivers who have common contagious diseases (such as chickenpox, group A streptococcal infections, respiratory infections, and infectious diarrhea) and for those who have less common but high-visibility public health problems (such as chronic hepatitis B or C or HIV infection) for which exposure-control guidelines have been published by the CDC and by the Society for Healthcare Epidemiology of America. Further Readings Bratzler DW, Hunt DR: The Surgical Infection Prevention and Surgical Care Improvement Projects: National initiatives to improve outcomes for patients having surgery. Clin Infect Dis 43:322, 2006 [PMID: 16804848] Centers for Disease Control and Prevention: Environmental infection control guidelines. Recommendations of the Healthcare Infection Control Practices Advisory Committee. MMWR 52(RR10):1, 2003 ———: Guideline for hand hygiene in health- care settings: Recommendations of the He althcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 51(RR-16):1, 2002 ——— : Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: Recommendat ions of CDC, the Infectious Diseases Society of America, and the American Society of Blood and Marrow Transplantation. MMWR 49(RR-10):1, 2000 Hota B, Weinstein RA: Basics work: Preventing infections in ICUs in developing countries. Crit Care Med 33:2133, 2005 [PMID: 16148500] McKibben Let al: Guidance on public reporting of healthcare- associated recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 26:580, 2005 [PMID: 16018435] Mermel LA et al: Guidelines for the management of intravascular catheter– related infections. Clin Infect Dis 32:1249, 2001 [PMID: 11303260] Strausbaugh LJet al: Preventing transmission of multidrug- resistant bacteria in health care settings: A tale of two guidelines. Cl in Infect Dis 42:828, 2006 [PMID: 16477561] Weinstein RA et al: Infection control report cards— securing patient safety. N Engl J Med 353:225, 2005 [PMID: 16034007] ———, Bonten MJ: Controlling antibiotic resistant bacteria: What's an intensivist to do? Crit Care Med 33:2446, 2005 Bibliography Centers for Disease Control and Prevention: Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. MMWR (in press) Centers for Disease Control and Prevention: G uideline for disinfection and sterilization in healthcare facilities. MMWR (in press) . Chapter 125. Health Care– Associated Infections (Part 11) Employee Health Service Issues An institution's employee health service is a critical component. Preventing infections in ICUs in developing countries. Crit Care Med 33:2133, 2005 [PMID: 16148500] McKibben Let al: Guidance on public reporting of healthcare- associated recommendations of the Healthcare. PEPLine (888-HIV-4 911). Protocols are also needed for dealing with caregivers who have common contagious diseases (such as chickenpox, group A streptococcal infections, respiratory infections, and