November 7, 2022 | Net Health

6 min read

History of Infectious Disease Outbreaks in EH/OM World

Healthcare workers (HCWs) have a high risk of coming into contact with infectious agents and bloodborne pathogens (BBP), including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, influenza (whether it’s seasonal flu or an outbreak of swine or avian flu), methicillin-resistant Staphylococcus aureus (MRSA), measles, and now, SARS-CoV-2 (which causes COVID-19). Because U.S. hospitals admit patients traveling from other parts of the world, HCWs may also face risks from diseases like Ebola, tuberculosis (TB), Severe Acute Respiratory Syndrome (SARS), or Middle East Respiratory Syndrome (MERS).1

Below, we’ll look at the history of disease outbreaks that inform the infection control measures managed by hospital Employee Health (EH) departments and Occupational Medicine (OccMed) clinics.  

U.S. Response to Disease Outbreaks in Healthcare Settings

In the United States, formal infection surveillance and control in hospitals was first recommended in 1958 by the American Hospital Association’s Advisory Committee on Infections Within Hospitals after multiple outbreaks of Staphylococcus aureus in American hospitals.2

In 1970, not only did the Centers for Disease Control (CDC) recommend that hospitals establish positions for infection control nurses and hospital epidemiologists, but the Occupational Safety and Health (OSH) Act of 1970 was also enacted to help ensure working conditions free from infectious disease for all workers.3 In 1991, OSHA established further standards and protections for HCWs in the Bloodborne Pathogens Standard.4

Today, many of the infection control measures hospitals abide by are laid out by the CDC in these documents: 

  • Guideline for Infection Control in Healthcare Personnel (“1998 Guideline”).5
  • Guidelines for Environmental Infection Control in Health-Care Facilities (2003)6 (and its updates7).
  • Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (a 2019 update to four sections of the 1998 Guideline).8 
  • Infection Control Objectives for a Personnel Health Service: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2021). 

Past Disease and Responses Outbreaks in the EH and OccMed World

In the late 20th and early 21st centuries, occupationally acquired hepatitis B, HIV, multidrug-resistant tuberculosis, and viral hemorrhagic fevers have been associated with the sickness and death of HCWs. Before that, diseases such as occupationally acquired tuberculosis, measles, diphtheria, and scarlet fever posed a greater risk.9 

Some notable outbreaks of infectious disease among healthcare workers include: 

Hepatitis B  
In 1983, the CDC estimated 10,000 U.S. healthcare workers contracted hepatitis B through occupational exposure. While the risk of hepatitis B has dramatically diminished with vaccine availability, a 2010 survey showed that only 63.4% of HCWs reported receiving all three doses of the HepB vaccine.10

The availability of the hepatitis B vaccine and booster doses led to a 95% decline in the disease in HCWs between 1983 and 1995 (an incidence rate 1.5x greater than that of the general U.S. population).11 However, between 2008 and 2019, hepatitis B outbreaks were reported in various outpatient clinics and pain management centers, primarily due to breaches in BBP protocol.12

H1N1 (novel Influenza A, aka “swine flu”)
In 2009, the H1N1 pandemic predominantly affected people under age 65, and influenza vaccines available at the time did not confer protection. HCWs were inordinately affected by the virus, but their increased exposure was partly tempered by their use of PPE.13

OSHA’s guidance for healthcare facilities described a comprehensive, pre-planned, but flexible approach that advised hospitals to arrange for occupational and employee health clinics to stockpile PPE supplies and antiviral medications and develop transparent distribution plans for their use.14

Measles 
During an Orange County measles outbreak in 2014, five HCWs developed secondary cases, even though four had been immunized. None wore the appropriate N95 respirators while initially working with measles patients, resulting in 1,014 exposures and time-consuming exposure investigations that turned up no additional exposures.15

Non-adherence to Personal Protective Equipment (PPE) measures and the presumption that childhood vaccination against measles confers lifetime immunity were among the contributing factors.16

Training in and the use of infection control practices, such as PPE and hygiene measures (handwashing), in the early stages of an epidemic or pandemic can help mitigate the increased risk of infection faced by healthcare workers. PPE usage and safe injection practices are crucial parts of HCW training. Between 2001 and 2011, lapses in adherence to these protocols were linked to 35 infection events and over 130,000 patient notifications in US healthcare settings.17  

How EH and OccMed Professionals Can Help Prevent Future Disease Outbreaks

EH departments and OccMed professionals have long played a role in properly recording infection incidents and encouraging adherence to BBP, PPE, and other infectious disease protocols. 

Tools such as EH and OccMed software assist in the kind of recordkeeping that helps hospitals and clinics track illness and exposure among HCWs, measures the efficacy of vaccines, illustrate connections between infections and breaches in safety protocols, measure costs related to worker’s compensation and occupational infectious disease transmission, and create guidelines and training materials to prevent future risks. 

Note: Net Health makes no representations as to accuracy, completeness, correctness, suitability, or validity of any of the information presented herein. All information is provided on an as-is basis. It is the viewer’s responsibility to verify any and all information presented herein.

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References:

1 National Institute for Occupational Safety and Health (NIOSH), “Healthcare Workers: Infectious Agents,” January 13, 2017.
2 Infection Control & Hospital Epidemiology, “Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report,” 1998.
3 Occupational Safety and Health Administration (OSHA), “OSH Act of 1970,” January 1, 2004. 
4 Occupational Safety and Health Administration (OSHA), “OSHA’s Bloodborne Pathogens Standard,” January 2011.
5 Centers for Disease Control (CDC), “Guideline for infection control in health care personnel, 1998,” June 1998.
6 Centers for Disease Control (CDC), “CDC’s Guidelines for Environmental Infection Control,” 2019. 
https://www.osha.gov/sites/default/files/CDC’s_Guidelines_for_Environmental_Infection_Control.pdf
7 Centers for Disease Control (CDC), “Guidelines for Environmental Infection Control in Health-Care Facilities (2003),” July 23, 2019. 
8 Centers for Disease Control (CDC), “Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (2019),” November 9, 2021.
9 Annals of Internal Medicine, “Occupationally acquired infections in health care workers. Parts I & II,” December 1, 1996.  
10 Public Health Reports, “Hepatitis B Vaccination Coverage Among
Health-Care Personnel in the United States
,” 2013.
11 Archives of Internal Medicine, “Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States,” December 8, 1997.
12 Centers for Disease Control (CDC), “Health care-Associated Hepatitis B and C Outbreaks (≥ 2 cases) Reported to the CDC 2008-2019,” May 11, 2020.
13 PLoS One, “The Occupational Risk of Influenza A (H1N1) Infection among Healthcare Personnel during the 2009 Pandemic: A Systematic Review and Meta-Analysis of Observational Studies,” August 31, 2016. 
14 Occupational Health and Safety Administration (OSHA), “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers,” 2009.
15 Centers for Disease Control (CDC), “Measles — United States, January 1–May 23, 2014,” June 6, 2014.
16 Clinical Infectious Diseases, “Healthcare Workers and Post-Elimination Era Measles: Lessons on Acquisition and Exposure Prevention,” January 15, 2016.
17 Medical Care, “Patient notification for bloodborne pathogen testing due to unsafe injection practices in the US health care settings, 2001-2011,” September 2012.

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