Definitions for the strength of recommendation grading (IA-IC, II, and no recommendation) are provided at the end of the "Major Recommendations" field.
Education and Training
II.A. Provide job- or task-specific education and training on preventing transmission of infectious agents associated with healthcare during orientation to the healthcare facility; update information periodically during ongoing education programs. Target all healthcare personnel for education and training, including but not limited to medical, nursing, clinical technicians, laboratory staff; property service (housekeeping), laundry, maintenance and dietary workers; students, contract staff and volunteers. Document competency initially and repeatedly, as appropriate, for the specific staff positions. Develop a system to ensure that healthcare personnel employed by outside agencies meet these education and training requirements through programs offered by the agencies or by participation in the healthcare facility's program designed for full-time personnel ("Guidelines for preventing," 1994; CDC, Boyce & Pittet, 2002; Larson et al., 2000; Pittet et al., 2000; Kidd, Heitkemper, & Kressel, 1999; Gould & Chamberlain, 1997; Calabro et al., 1998; Haiduven et al., 1998; Macartney et al., 2000; Sokas, Simmen, & Scott, 1993; Bonten, Kollef, & Hall, 2004; Lau et al., 2004; Diekema et al., 1995; Simor et al., 2002; O'Grady et al., 2002; Eveillard et al., 2001). Category IB
II.A.1. Include in education and training programs, information concerning use of vaccines as an adjunctive infection control measure (Bolyard et al., 1998; Harper et al., 2005; Talbot et al., 2005; "Immunization," 1997). Category IB
II.A.2. Enhance education and training by applying principles of adult learning, using reading level and language appropriate material for the target audience, and using online educational tools available to the institution (Jeffe et al., 1999; Goldrick, Gruendemann, & Larson, 1993; Davis et al., 1999; Caffarella, 2001; Sargeant et al., 2004; Cole & Glass, 2004; Pfeiffer & Gilmore, 2000). Category IB
II.B. Provide instructional materials for patients and visitors on recommended hand hygiene and Respiratory Hygiene/Cough Etiquette practices and the application of Transmission-Based Precautions (Srinivasan et al., 2004; McGuckin et al., 2004; Cirone, 1997; Weinstock et al., 2000). Category II
Definitions:
Strength of the Recommendations
The recommendations are categorized on the basis of existing scientific data, theoretical rational, applicability, and when possible, economic impact, as follows:
Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IB. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Category IC. Required for implementation, as mandated by federal and/or state regulation or standard.
Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.
No recommendation; unresolved issue. Practices for which insufficient evidence or consensus regarding efficacy exists.
