Occupational infections in health care workers: prevention and intervention

Health care workers may be exposed to a variety of infections as they carry out their job responsibilities. Guidelines have been issued for prophylaxis following exposure to blood or body fluids known to be infected with the human immunodeficiency virus. Hepatitis B vaccine must be offered to all workers who may be exposed to blood and body fluids. Chemoprophylaxis is not available for workers exposed to hepatitis C. Health care facilities must conduct a tuberculosis risk assessment, provide skin testing at least yearly and develop isolation procedures for potentially infectious patients. The Occupational Safety and Health Administration currently mandates two-stage skin testing for all new employees at risk for tuberculosis exposure who have not had a skin test in the past year. Recent skin-test converters should be evaluated for isoniazid prophylaxis after a chest radiograph rules out active tuberculosis. Workers should be removed from the workplace from days 10 to 21 following exposure to varicella infection; vaccination of nonimmune workers should be considered. Because of possible side effects, the standard pertussis vaccine is not used in adults, but a new acellular pertussis vaccine has been effective in this group.