Prevention and management of infectious or communicable diseases in healthcare workers.

Approximately 5.6 million healthcare workers are at risk of occupational exposure to bloodborne pathogens and other infectious materials in the United States (Yun et al., 2023). Protecting these workers is a foundational element of a healthcare organization’s general program for infection control and prevention.

An infectious disease is a clinically manifested disease of humans or animals resulting from an infection. A communicable disease is an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent from an infected person, animal, or inanimate source to a susceptible host. 

Occupational health strategies, as applied to infection control, are a set of activities intended to assess, prevent, and control infections and communicable diseases in healthcare workers.

Healthcare personnel include paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. These personnel include those involved in direct patient care, students and trainees, contractual staff, and personnel not directly involved in patient care but potentially exposed to infectious agents.

Protecting healthcare workers is an integral part of a healthcare organization’s general program for infection control and prevention. This includes:

• educating personnel about the principles of infection control
• working with the infection control department to monitor and investigate potentially harmful infectious exposures and outbreaks among personnel
• providing care to personnel for work-related illnesses or exposures
• identifying work-related infection risks
• instituting appropriate preventive measures

Preventing infectious diseases and occupational injuries reduces absenteeism and disability, ensures a safe work environment for all personnel, and decreases the transmission of infectious agents.

6.1 Infection Control Training

All licensed healthcare professionals in New York State are required to receive training on infection control and barrier precautions every four years through a NYS- approved provider. Documentation of appropriate training must be maintained both by the course provider and course participant.

All new employees, or employees being transferred into jobs involving potential exposure to blood or OPIM, must receive bloodborne pathogen training before assignment to tasks where an occupational exposure may occur. Retraining is required annually, or when changes in procedures or tasks affecting occupational exposure occur.

Healthcare personnel must be informed of the possible health effects of exposure to infectious agents (such as hepatitis B, hepatitis C, and HIV) and hazardous chemicals (such as ethylene oxide and formaldehyde). Information must be consistent with OSHA requirements, and facilities must identify the specific areas and tasks where potential exposure exists.

6.1.1 Infectious Agents

Occupational exposure to bloodborne pathogens is governed by OSHA’s Bloodborne Pathogens Standard (29 CFR 1910.1030). Employers must implement safety measures such as universal precautions, make the hepatitis B vaccine available, and offer post-exposure evaluation and follow-up.

Personal Protective Equipment (PPE) Training and Protocols

Healthcare workers must receive training in the selection and proper use of personal protective equipment (PPE). Employers must ensure that workers wear appropriate PPE to prevent exposure to infectious agents or chemicals. The employer is responsible for making such equipment and training available at no cost to their employees, in accordance with OSHA’s Personal Protective Equipment Standard (29 CFR 1910 Subpart I) and the Bloodborne Pathogens Standard.

6.1.2 Occupational Monitoring Programs

Healthcare facilities must establish a program for monitoring occupational exposure to regulated chemicals that adheres to state and federal regulations. This includes initial determination, periodic monitoring, employee notification within 15 days of results, and the maintenance of employee medical and exposure records (29 CFR 1910.1047; 29 CFR 1910.1048). 

6.1.3 Dermatological Restrictions and Guidelines

Healthcare workers with exudative lesions or weeping dermatitis of the hands must be excluded from direct patient care activities and handling patient care equipment until the condition resolves, minimizing the risk of transmitting infectious materials or exacerbating skin barrier disruption.

6.2 Medical Assessments

The NYSDOH Code 405.3 requires that all healthcare workers in New York be medically evaluated prior to employment in hospitals and diagnostic and treatment centers. This evaluation must include:

• a medical history physical exam
• documentation of immunity for measles, mumps, rubella (MMR), varicella, and hepatitis B, as well as current status for tetanus, diphtheria, and pertussis (Tdap)
• baseline (pre-placement) tuberculosis (TB) screening consisting of:
  • Individual risk assessment
  • Symptom evaluation
  • TB testing

Routine annual TB testing is no longer recommended unless there is a known exposure or ongoing transmission. Although universal annual testing has been phased out, the following requirements remain (CDC, 2019):

• All personnel must receive yearly education on TB risk factors, signs/symptoms, and infection control protocols.
• Facilities may still elect to perform testing for personnel in high-risk roles or settings.
• Personnel with untreated latent TB infection should undergo an annual symptom screen to ensure they have not progressed to active disease.

6.3 Vaccines

6.3.1 Measles, Mumps, and Rubella (MMR)

Current New York State regulations (10 NYCRR Section 405.3) require all healthcare personnel to demonstrate immunity to measles and rubella. While mumps immunity is highly recommended by the CDC and required by many New York facilities to prevent outbreaks, the state's legal mandate focuses primarily on measles and rubella.

For personnel born in 1957 or later, immunity is established by:

• Documented positive serologic titers for measles, mumps, and rubella. Results labeled as "equivocal" or "indeterminate" must be treated as non-immune.
• Vaccination records:
  • Measles and mumps: Two doses of live virus vaccine, with the first dose administered on or after the first birthday and the second dose at least 28 days later.
  • Rubella: At least one dose of live virus vaccine administered on or after the first birthday.

For personnel born before 1957:

• Rubella: Birth before 1957 is not acceptable evidence of immunity in New York. Personnel must have a positive titer or documentation of at least one dose of the rubella vaccine.
• Measles and mumps: While birth before 1957 generally suggests naturally acquired immunity, the CDC and NYSDOH strongly recommend at least one dose of MMR for unvaccinated personnel in this age group who do not have laboratory proof of immunity.
• Outbreak protocol: During a mumps or measles outbreak, healthcare facilities should provide two doses of MMR vaccine to personnel born before 1957 who lack evidence of immunity (CDC, 2024).

6.3.2 Hepatitis B Virus (HBV)

Employers must provide the Hepatitis B vaccine series to all employees with occupational exposure risk within 10 days of initial assignment at no cost.

Vaccination and post-vaccination testing include (CDC, 2025, August 29):

• Primary series: HCP should receive the standard three-dose series (0, 1, and 6 months) or the FDA-approved two-dose series (Heplisav-B) administered 1 month apart.
• Serologic testing: Antibody testing (anti-HBs) must be performed 1–2 months after the final dose of the series.
  • Immune: no further testing or boosters are needed
  • Non-responder: the individual should complete a second vaccine series.
• Second series: If the second series fails to produce immunity, the person is a "non-responder. Non-responders must be tested for HBsAg to rule out chronic infection. If negative for HBsAg, they are considered susceptible and must receive Hepatitis B Immune Globulin (HBIG) following any significant exposure.

6.3.3 Hepatitis C Virus (HCV)

Hepatitis C management shifted significantly following the 2020 CDC updated guidelines, which remain the standard in 2026. Clinicians should universally screen (CDC, 2025, January 31):

• all adults 18 and older at least once in their lifetime, except in settings where the prevalence of hepatitis C virus (HCV) infection (HCV RNA-positivity) is under 0.1%
• all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is under 0.1%

Clinicians should use an FDA-approved HCV antibody test followed by an NAT for HCV RNA test when antibody is positive/reactive. Tests include CDC, 2025, January 31):

• HCV antibody test (anti-HCV, e.g., enzyme immunoassay [EIA])
• Nucleic acid test (NAT) to detect presence and levels (quantitative) of HCV RNA.

Follow-up testing is typically performed at 3 to 6 weeks (HCV RNA) or 4 to 6 months (anti-HCV) to detect early infection, as modern antiviral treatments are highly effective when started early).

There is no vaccine or effective immunoglobulin (PEP) for HCV. There is no vaccine to prevent hepatitis C. Therefore, the best way to prevent infection is by avoiding behaviors that can transmit the virus.

6.3.4 Influenza (Flu)

Current NYSDOH regulations (Section 2.59 of the State Sanitary Code) require all healthcare facilities to provide annual influenza vaccinations to personnel. Personnel who are not vaccinated against the current season's influenza must wear a surgical or procedure mask while in areas where patients or residents are present during the time when influenza is prevalent.

Routine annual influenza vaccination of all persons aged ≥6 months who do not have a contraindication to vaccination continues to be recommended. Flu vaccine types include (Grohskopf et al., 2025):

• Quadrivalent Inactivated Influenza Vaccine (IIV4): The standard injectable vaccine covering four strains.
• Recombinant Influenza Vaccine (RIV4): Egg-free injectable option.
• Live Attenuated Influenza Vaccine (LAIV4): Nasal spray for healthy, non-pregnant individuals aged 2 to 49. Contraindication: LAIV should not be used by healthcare personnel caring for patients in protected environments (e.g., bone marrow transplant units).

6.3.5 Other Recommended or Mandate Requirements

Pertussis: All healthcare personnel must maintain up-to-date protection against pertussis, especially to protect vulnerable patient populations.

Tdap: Healthcare personnel who have not previously received a dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) should receive one dose as soon as possible, regardless of the interval since their last Td booster. Vaccination remains a critical priority for healthcare workers with direct contact with infants under 12 months of age and pregnant patients (CDC, 2025 June).

Following the initial Tdap, healthcare personnel should receive a booster dose of either Tdap or Td every 10 years. Tdap is now preferred over Td for these decennial boosters to maintain pertussis immunity. Healthcare personnel who are pregnant should receive a dose of Tdap during each pregnancy (ideally between 27 and 36 weeks’ gestation) to provide passive immunity to the newborn (CDC, 2025 June).

Chickenpox: Varicella (chickenpox): The NYSDOH requires evidence of immunity to varicella for all healthcare personnel. Evidence of Immunity is defined by at least one of the following (CDC, 2025 June):

• Documentation of vaccination: Two doses of varicella-containing vaccine administered at least 28 days apart.
• Laboratory evidence: Documented positive serologic titers for varicella-zoster virus (VZV) IgG.
• Diagnosis history: Documentation of a history of varicella (chickenpox) or herpes zoster (shingles) based on diagnosis by a healthcare provider.

Susceptible personnel who lack evidence of immunity should receive the two-dose vaccine series before or at the start of employment.

6.3.6 Work Restrictions and Symptom Management

In accordance with updated infection control protocols, New York State healthcare facilities must implement strict “illness-at-work” policies to prevent healthcare-associated infections. Healthcare personnel must be evaluated immediately if they exhibit symptoms of potentially communicable diseases, including but not limited to:

• fever, persistent cough, or shortness of breath
• new or unexplained rash or skin lesions
• draining wounds or localized skin infections
• active vomiting or diarrhea

Healthcare personnel exhibiting these symptoms must be excluded from direct patient contact and common staff areas until they are clinically determined to be non-infectious. During the "prevalent" respiratory virus season (typically late fall through spring), specific masking mandates may apply for personnel not vaccinated against influenza (NYSDOH, 2026, April).