A Cost-Effective Employee Health ProgramAuthor(s): William M. ValentiSource: Infection Control, Vol. 5, No. 8 (Aug., 1984), pp. 405-406Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/30145015 .

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Infection Contro and Empoyee Health

By William M. Valenti, MD

A Cost-Effective Employee Health Program

In the 1980s when the emphasis in health care is on cost containment and prospective reimbursement, programs that do not generate income (ie, infection control, employee health, quality assurance, utilization review, etc.) need to demonstrate an appreciation for the finan- cial constraints under which health care institutions will be operating. It is important, therefore, to develop pro- grams that are streamlined, efficient, and avoid duplica- tion of effort. It is also important to avoid any unnecessary rituals in any of these programs. The rationale of "we've always done it this way," or "I just feel better if we do this" no longer can bejustified at a time when cost containment is so vitally important. How will prospective reimburse- ment affect the employee health service? This is a difficult question to answer, but based on past experience we might expect one of two things to happen: 1. A cut in the budget for the employee health program,

or 2. No yearly or periodic increments in the budget allo-

cated for the employee health program. One could argue that by maintaining the good health

of employees, it should be possible to maintain or increase employee productivity and therefore decrease costs for time off from work, disability, workmen's compensation, etc. This is probably true, but is extremely difficult to document. The most rational approach then to dealing with cost effectiveness from the employee health stand- point is to have a program that is reasonable, rational, and workable for the individual institution without taxing the institution's resources. The emphasis in employee health should be on disease prevention. Remember, frills cost money.

Organization of the Program There are several organizational models for an

employee health program (Figure). All of these models really emphasize the role of the employee health program as an infection control program for personnel. Therefore,

regardless of the model under which the employee health program is operating, communication with the infection control program is absolutely essential. I personally pre- fer Option A. This model is one in which a single admin- istrator directs both the employee health and infection control programs. This type of program has evolved at the University of Rochester and several other institutions over the past several years and seems to work quite efficiently as there is regular and frequent communication between infection control personnel and employee health person- nel. The employee health program focuses on infection control for employees and the infection control program focuses on infection control activities for patients. Although there are separate staffs working in both pro- grams, all personnel meet with each other on a regular basis and communicate regularly. Additional continuity is provided by a single administrator.

Since this type of organizational structure may not be possible in all institutions, other options may be consid- ered. Option B involves two separate programs for infec- tion control - one for patients and one for personnel - which are administered by different directors and staffed by different people. With this model, communication between the personnel working in both programs once again becomes the essential link that insures continuity and some degree of consistency in program operations.

Option C is another possible model which is used in many hospitals in the US. In this case, the infection con- trol practitioner and the employee health practitioner are the same person reporting to one or more administrators. Once again, the model for program organization should vary with the institution. The crucial link between the programs should be regular and frequent communica- tion.

Operational Aspects There are a number of areas where infection control

and employee health can collaborate to result in a more

INFECTION CONTROL 1984/Vol. 5, No. 8 405

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DIRECTOR

II I

A

-- COMMUNICATION E

DIRECTOR DIRECTOR

I I C E COMMUNICATION - C

B DRDRTOR I DIRECTOR

I EH/IC

Figure. Organizational models for an employee health program.

streamlined, efficient infection control program for hos- pital employees. Some of these areas are: policy develop- ment, protocols for dealing with exposures to infectious diseases, preventive programs such as programs for vac- cination with influenza or hepatitis B vaccines, protocols for evaluation of acute infectious illnesses in employees and investigations of outbreaks of infection. The advan- tages of this collaborative effort are that consultation between the two groups will utilize the strengths of both programs. Also, both infection control and employee health personnel will know what the other is doing. It is a much more comprehensive approach to infection control and employee health and recognizes the fact that there is a fair amount of overlap when dealing with infection con-

trol activities as they involve hospital employees. Finally, this collaboration should also permit the health care facil- ity to fulfill an important infection control objective which is to create a safe environment for patients, personnel, and visitors.

When one considers the various options available for the delivery of care to employees, this collaborative effort becomes very important. Ideally, employee health activities should take place in the employee health service office which may be staffed by physicians, nurses, nurse practitioners, and/or physician's assistants. However, this ideal model really cannot occur in all institutions and therefore, employees may be seen in the emergency department by emergency room personnel or may be referred to outside physicians or consultants. When employees are seen in the emergency department or by outside physicians, infection control personnel may have less input into the delivery of infection control services to employees. However, it is essential that emergency room personnel and outside physicians know what is expected of them in terms of dealing with various infectious disease problems including exposures, work restrictions, work- related illnesses, etc. The best way to accomplish this is to have a series of written protocols which address the infec- tion control problems which are seen most frequently among employees. A good starting point for this would be to develop a protocol for dealing with needle sticks and exposures to hepatitis B in an attempt to have some uni- formity and consistency in terms of the way these prob- lems are managed.

In summary, infection control and employee health programs should work together to develop joint activities for infection control for employees. The two disciplines bring a number of strengths to these joint activities which should result in a more efficient program and present a unified front to personnel. Presenting a consistent mes- sage to employees who use these services can be very important for the credibility of both programs. Hopefully, it will encourage the utilization of services when appro- priate and should result in a smoother running program that is up-to-date, reflects appropriate infection control/ employee health practices, and is cost-effective.

406 Infection Control and Employee Health/Valenti

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