Handbook of Operating Procedures > Series 400 Budget, Finance and Operations > 4.26.1 Communicable Disease

4.26.1 Communicable Disease

A. Purpose

To reduce transmission of communicable disease among staff, patients, others at the University, and the community.

B. Persons Affected

To University of Texas at Tyler campuses.

C. Definitions

CDC – Centers for Disease Prevention and Control

IPC – Infection Prevention Committee

Communicable disease -- one caused by an infectious agent and transmissible from one person to another, directly or indirectly

D. Policy

1. For the purposes of infection control, the guidelines in this policy will be utilized by Occupational Health for managing personnel with physician-diagnosed infections and significant exposures to communicable diseases. 
2. This policy seeks to reduce transmission of communicable disease among staff, patients, independent practitioners, and the community. All staff members and other persons at the University are expected to comply with employee health and infection control and communicable disease policies and procedures as a condition of employment/work. 
3. This policy identifies potential work restrictions due to specific communicable diseases. 
4. This policy provides a comprehensive infection control system that maximizes protection against communicable diseases for all staff members, other workers, and for the public that they serve, and the following guidelines are established by the University for managing personnel who are infected with or exposed to communicable diseases. 

The University recognizes that communicable disease exposure maybe an occupational health hazard. Although each person is ultimately responsible for his/her own health, the University recognizes a responsibility to provide as safe workplace and provide all employees and other persons with the best available protection from occupationally acquired communicable disease. Decisions involving persons who have communicable diseases will be based on:

1. Current and well-informed medical judgments concerning the disease.
2. The risks of transmitting the illness to others.
3. The symptoms and special circumstances of each person who has a communicable disease.
4. A careful weighing of the identified risks and the available alternatives for responding to a person with a communicable disease.

Common communicable diseases include measles, influenza, viral hepatitis-A (infectious hepatitis), viral hepatitis-B (serum hepatitis), human immunodeficiency virus (HIV infection), AIDS, Severe Acute Respiratory Syndrome (SARS) and tuberculosis. Other communicable diseases/infections include, but are not limited to: diarrhea with fever; new cough lasting more than 3 days; skin infections; large cold sores; shingles; meningitis; mumps; pertussis (whooping cough); chicken pox;, lice; and conjunctivitis ("pink eye").

The University may change this definition from time to time if in its best interest and in accordance with CDC. The University will not discriminate against any job applicant or employee or other person based on the person having a communicable disease. Applicants, employees, and others will not be denied access to the University solely on the grounds that they have a communicable disease. The University reserves the right to exclude a person with a communicable disease from its facilities, programs and functions if it finds, based on a medical determination, such restriction is necessary for the welfare of the person who has the communicable disease and/or the welfare of others within its facilities, including patients.

The University will comply with applicable statutes and regulations that protect the privacy of persons who have communicable disease.

The University makes screening for exposure and/or immunity to infectious disease available to persons who may come in contact with infections at the University, and for which screening is clinically available. When persons have, or are suspected of having, an infectious disease that puts others at risk, the University provides them with, or refers them for, assessment, testing, immunizations, prophylaxis/treatment or counseling. Persons who continue to work while ill may deliver suboptimal care and represent a significant morbidity risk to their coworkers, patients, visitors and others. The ill person should restrict his/her activities to prevent spread of the infecting agent to others. All persons should remain away from the University until no longer contagious or cleared by a medical provider as needed. Any person exposed to a communicable disease should be evaluated by his/her medical provider.  In some instances, completely excluding a person from the workplace is not feasible. Under these circumstances, ill or recovering persons should be transferred to duties which restrict them from any direct patient contact and limit coworker contact.

Employee Protection

1. All new employees will be offered MMR, Tdap, influenza, and Varicella vaccines if needed. New employees will be required to show proof of immunity or immunization for MMR, Tdap or Td as appropriate and Varicella. Employees at risk for bloodborne pathogen exposure will be offered Hepatitis B vaccine. (See IHOP 08.17, Vaccine Preventable Disease) 
2. The University offers annual influenza vaccine to employees free of charge. Employee Health and Infection Prevention educates staff and others about the influenza vaccine, non-vaccine control and prevention measures, and the diagnosis, transmission, and impact of influenza (See IHOP Vaccine Preventable Disease). 
   1. After exposure, appropriate prophylaxis/screening is offered for tuberculosis infection, HIV, scabies, viral hepatitis, invasive meningococcal infections, pertussis, chickenpox, measles, mumps, and rubella and other applicable infectious diseases. 
   2. Persons are expected to sanitize their hands after contact with respiratory secretions and contaminated objects/materials. 
   3. Persons are to observe Droplet Precautions, in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until the cause of symptoms is determined to not be an infectious agent that requires Droplet Precautions. 
   4. Persons with signs and symptoms of a transmissible infectious disease of significant epidemiologic importance, and those who have been exposed to such diseases, should report immediately to their supervisor and/or Employee Health. The illness or exposure will be reported to Infection Prevention by Employee Health for an epidemiological investigation 

Work Related Exposures

1. For clinical operations, if a patient is admitted to the University with a significant communicable disease for which prompt isolation was not initiated, Infection Prevention should be notified immediately. An employee or other worker's immediate supervisor should be notified promptly of exposure to communicable disease. Infection Prevention will conduct an epidemiological investigation, notify the Occupational Health Clinic (OHC) of the exposure case, and provide OHC with the source data. The OHC will collaborate with the supervisor(s) to identify additional persons who may have been exposed. OHC will provide evaluation, management, and follow-up of potential exposures. 
2. OHC will identify, evaluate, manage staff and other notifications and follow-up in all exposure cases. Persons identified as contacts in an exposure case will be directed to complete a First Report of Injury. 
   1. Bloodborne Pathogen Exposures (See IHOP Bloodborne Pathogen Exposure Control Plan) 
      1. Bloodborne pathogen exposures/needle sticks must be reported promptly to Infection Prevention to assure prophylactic treatment is administered in a timely manner, if indicated, since some treatments need to be initiated within 2 hours of exposure for maximum effectiveness. 
      2. A First Report of Injury form should be completed, and the employee should report to Employee Health (or Emergency Care Center [ECC] if injury occurs after hours) for evaluation and prophylaxis if indicated. 
   2. Airborne and other exposures: 
      1. Infection Prevention should be notified of any possible exposures to airborne communicable diseases. Infection Prevention will notify OHC of the exposure case and provide the source case data. 
      2. The person's supervisor will provide OHC with a list of staff members who have had significant contact with an infected person before the diagnosis of a communicable disease was known or before appropriate precautions were taken. 
      3. The First Report of Injury form should be completed for each exposed employee. 
      4. The person must report to OHC or ECC if exposure occurs after clinic hours and needs immediate intervention for assessment and treatment. 
      5. A person exposed to measles, mumps, rubella, hepatitis B, chicken pox or any other applicable infectious disease may have his/her immune status determined by history or lab work and appropriate prophylaxis will be provided if indicated. 

Non-Work Related Exposures

1. A person who knows or suspects that he/she has been exposed to a communicable disease that could impact patient care (e.g., tuberculosis, pertussis, meningococcemia, chicken pox, etc.) should contact OHC or Infection Prevention for guidance regarding work status change requirements. 
2. The person shall also report the exposure or possible exposure to his/her immediate supervisor. If work status change is required, the person must contact his/her immediate supervisor.

Communicable Diseases

1. A person who is diagnosed as having a communicable disease that could impact patient care or who has missed more than 3 days of work due to an infection must be approved by OHC to return to work. Persons on extended leave (five days or more for an infection) are required to have a release to work from their primary care provider. 
2. Persons who have exudative lesions or weeping dermatitis will refrain from all direct patient care, processing culture specimens, preparing food and from handling patient care equipment until the condition resolves and the person is released by OHC. 
3. Persons who have herpes simplex lesions, either orofacial lesions ("cold sores") or herpetic whitlows (typically lesions on fingers) should be evaluated by OHC to determine their potential for transmitting herpes simplex to patients. Evaluation will consider: 
   1. Extent of lesions. 
   2. Patient population served. 
   3. Based on evaluation, the person may be excluded from work until lesions have crusted, be reassigned to less seriously ill patients, or allowed to work using appropriate barriers such as masks or gloves. 
4. Persons who are acutely ill with fever, severe cough, vomiting, diarrhea, or other signs of contagious illnesses should not report to work and, if they become ill after coming to work, they should go home. Employees off work ill with a fever (greater than 100◦F(37.8◦C)) should be fever free without the aid of fever reducing medications (e.g., Tylenol, ibuprofen, etc.) for 24 hours before returning to work. 
5. For a more extensive list of current diseases/infections, work restrictions, and duration of restriction to which the University adheres, see Appendix A to this policy. 

Employee Categories

1. These guidelines restrict ill and exposed employees based upon patient contact (i.e., direct, indirect, and non-patient care providers). Supervisors should collaborate with OHC and Infection Prevention on questions concerning work restrictions or reassignment during an illness or incubation period. Employee categories are defined as follows:
2. Direct patient care providers are University employees who are directly responsible for the care, diagnosis, and treatment of patients (e.g., physicians, nurses, radiology technicians, phlebotomists, chaplains, social workers, therapists).
3. Indirect patient care providers are University employees who are not responsible for patient care; however, they interact with patients (e.g., health unit coordinators, unit assistants, registration clerks, admitting clerks and volunteers).
4. Non-patient care providers are University employees who have no patient contact (e.g., research laboratory staff, accounting and payroll personnel, Medical Records employees).
5. Symptomatic and exposed personnel for which job reassignment is approved should adhere to the infection control work conditions to ensure susceptible co-workers, patients, and visitors are not exposed. OHC and Infection Prevention should be consulted if there are issues or disagreements with these guidelines.
6. OHC does not provide primary care for employees. Employees are encouraged to seek medical advice or treatment from providers of their choice. However, certain infectious diseases or exposures may dictate that the employee be evaluated by OHC to ensure appropriate prophylaxis, testing, work restrictions, and reporting.
7. Due to the variety of University job categories, in the event personnel or supervisors believe an exception to these guidelines exists, OHC and Infection Prevention should be consulted.
8. Infection Prevention is mandated by The Joint Commission to maintain records of incidents related to infections and communicable diseases occurring among employees in order to facilitate epidemiological investigations for evidence of clusters/outbreaks and to initiate appropriate action. OHC will enter exposure data in the facility database and provide a report concerning persons evaluated for communicable infections and exposures to communicable diseases to Infection Prevention.

Patient and Visitor Expectations

1. Patients with diagnoses that may suggest tuberculosis such as hemoptysis, cavitary lesions, etc., or obvious respiratory symptoms should be screened with the Respiratory Symptoms Questionnaire at first point of entry into the University and appropriate precautions implemented if tuberculosis is suspected.
2. Patients and visitors are expected to comply with "respiratory etiquette" while at the University by covering their coughs and sneezes, using tissues, and sanitizing their hands by washing or using an alcohol hand hygiene product. To encourage compliance, these items should be readily accessible to them in the waiting rooms.
3. Coughing persons in waiting rooms should be asked to wear masks and, when space and chair availability permit, encouraged to sit at least three feet away from others in common waiting areas.
4. Patients and visitors are expected to comply with isolation precautions. Nursing or other staff will educate patients and visitors on the appropriate precautions.

APPENDIX A

In the absence of state and local regulations, the following table provides a summary of work restrictions for persons exposed to, or infected with, infectious diseases of importance in health care settings.