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Spring Journal

Volume 31, Issue 1

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Today’s headlines are full of disturbing stories about new occurrences and outbreaks of infectious diseases. Some of them such as SARS (Severe Acute Respiratory Syndrome), monkeypox, and West Nile virus are new and alarming. In addition, the threat of bioterrorism with deadly agents such as anthrax and smallpox continues to be a concern.

Although the Occupational Safety and Health Administration (OSHA) has specific rules to protect workers from exposure to blood-borne infections such as hepatitis and HIV, there are many other infections that can affect the workforce, which ultimately impacts corporate productivity and profits. Even though most infections are not occupationally acquired, health and safety programs should be proactive in identifying potential infectious threats to the workforce and preventing them when possible. From a public health and safety perspective, preventing illness and injury are the primary goals.

With the exception of healthcare workers and first responders, most employees in the U.S. are not at risk for acquiring occupational infections. However, many people get exposed to a variety of infections at home, in the community, and also from fellow workers. Employers should be proactive by addressing these potential risks through their health and safety programs with the support of their human resources departments.

Some of the most common infections are respiratory viruses such as colds and influenza. Although not considered an occupational exposure, per se, people frequently are exposed to these common infections while at work. An employer can take several steps to minimize the potential spread of respiratory viral infections in the workplace. The modest cost of providing influenza vaccine to employees every fall, before flu season is in full swing, can save significant time and money. The more employees who are immunized, the better. This reduces potential exposure for non-immunized employees while at work. It also reduces the number of people in the workforce who may become exposed to the flu from family or community. Overall, provision of flu vaccine is a win/win situation for both employers and their staffs.


Unfortunately, there are no vaccines for most other common respiratory viruses, so preventive efforts take a different course. There are many common sense approaches, such as the provision of adequate, accessible handwashing facilities; education about how viruses are transmitted; and encouragement of employees to stay home and use their sick time if they have signs and symptoms of respiratory infection, particularly if they have a fever. This is especially important in the winter when there are viruses other than the common cold in circulation.

The one bacterial respiratory infection that can be quite contagious in an indoor workspace is tuberculosis, or TB. Although TB has decreased in the U.S. each year since its modern peak in 1992, according to the Centers for Disease Control and Prevention (CDC), there were almost 16,000 cases reported in 2001, with the majority in foreign-born individuals. A person with an active case of pulmonary (lung) TB who works in a confined, indoor workspace with others can readily expose and infect fellow workers. Unfortunately, this is a particular occupational risk for workers within correctional facilities due to their exposure to inmates who are actively infected.


To prevent spread of TB in the workplace, an employer should be especially aware of signs and symptoms of active TB infection, which include weight loss, poor appetite, fever, night sweats, and a bad cough that may cause the individual to cough up blood. Awareness of potentially infected workers is especially important in immigrant populations where the rate of TB infection, is higher.

If there is any suspicion that employees may have active TB, they should be referred to their primary care physician for diagnosis and treatment. If they do not have a private doctor, most local health departments have programs for diagnosis and treatment of TB. If active TB is confirmed, other employees may have been exposed at work, and the employer should immediately notify the local health department. The health department will interview staff to determine who has been exposed, obtain medical histories, perform skin tests, and provide medication, when needed. Skin tests, or PPDs, are done as soon as an exposure is identified and then 12 weeks after the exposure to determine if an infection has occurred. Not everyone who is exposed to TB will “convert” the skin test to positive. If exposures occur in the workplace, they should be recorded on the OSHA log.

While TB is an old disease, there are several new infectious diseases that have recently emerged in the U.S. and elsewhere that may cause concern to employees. The key here is to distinguish infections that can be transmitted from one person to another from those that come from some other environmental source. For example, West Nile virus can be a serious ailment, severely affecting the brain. However, this virus is spread through mosquitoes and cannot be passed on from an infected person to someone else. This makes it unlikely to be an occupationally acquired infection, unless someone’s job requires outdoor work and he/she becomes exposed while on the job.

In June 2003, several cases of monkeypox were diagnosed in the U.S. These cases were the result of exposure to an infected pet prairie dog. Thus, monkeypox should not be an occupational risk unless one works with animals that are infected. It can be transmitted from one person to the other after lengthy face-to-face exposure.

In contrast, it appears that SARS can be very contagious and has already been reported as an occupational infection in healthcare workers in Toronto and Hong Kong. It is prudent for employers to maintain vigilance on this newly emerging viral infection. Fortunately, there have been few SARS infections in the U.S., and in most cases the individual was exposed while outside the country. The lesson here is, even if SARS does not occur with frequency in this country, companies doing international business should check the CDC Web site for travel warnings and avoid sending staff to cities where cases are occurring. If SARS becomes more common in the U.S., identification of exposures and exclusion from the workplace as soon as signs and symptoms occur will be primary in preventing the spread of infection.

Finally, the potential exposure to agents of bioterrorism (BT) is an ongoing concern. The CDC has identified several specific infectious agents that may be used by terrorists, including smallpox virus and bacteria, such as anthrax, botulism, and plague. We have already experienced anthrax exposures with several deaths in the U.S. in 2001 and 2002, with many postal workers exposed and several infected.

At this point, the most prudent approach for employers is to (1) be aware of these threats, (2) assess their particular vulnerability for exposure to BT agents, (3) implement appropriate safety and security strategies to prevent breaches and potential exposures, and (4) watch the Web sites of the CDC, as well as the Department of Homeland Security, for any new advisories or recommendations.

Humans have shared the earth with various organisms for many millennia, and we will continue to be challenged with both old and new organisms that can cause infections in humans. Employers should continue their education and awareness of the infections, as well as the prevention strategies, in order to protect the productivity of their respective companies and the well being of their employees.

Emily Rhinehart, RN, MPH, CIC, CPHQ, is a vice president at AIG Consultants, Inc., healthcare division. She has spent 25 years in healthcare infection control, risk and quality management. She has published many articles and books on infectious disease topics.