OBJECTIVES (10 QUESTIONS)

Review and/or develop screening and immunization programs

Provide counseling, follow-up, work restriction recommendations related to communicable disease or following exposures

Assist with analysis and trending of occupational exposure incidents and information exchange between occupational health and infection prevention and control departments

Assess risk for occupational exposure to infectious diseases (eg, TB, bloodborne pathogens)

EMPLOYEE/OCCUPATIONAL HEALTH PROGRAMS

PROGRAM OBJECTIVES(RELATED TO INFECTION PREVENTION)

Educate personnel Principles of IP and personnel’s role in prevention

Collaborate with IP Monitor and investigate exposures and outbreaks

Provide care to personnel Work-related illness or exposure

Identify risk and institute preventive measures Work-related infection risks

Contain costs by preventing infectious diseases Absenteeism and disability

OPERATIONS

Screening Education and counseling Occupational illness and injury treatment Nonoccupational illness treatment Preventive health services Environmental assessment and control Record keeping

COMMUNICATION WITH IP

Personnel exposure Personnel infections Community and personnel outbreaks Policies and procedures Educational programs for personnel

HEALTHCARE PERSONNEL

“All 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.”

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

POLICIES & PROCEDURES

Work restrictions Authority to remove personnel from duty

Criteria for exposure and prophylaxis Screening procedures Illness reporting system Methods of detecting, preventing, &

controlling disease Protocols for treatment

Occupational injuries and illnesses Nonoccupational illness

EDUCATION

New employee orientation & annual updates Postexposure counseling (Bloodborne

Pathogens) TB screening and positive conversions Worker’s comp issues Pregnant worker concerns Community-acquired infections Influenza prevention MMR & Varicella protection and prevention Screening test results Guidelines for illness

ACTION PLAN: DETECTION

History of disease Symptoms Labs Reporting cases to health department

ACTION PLAN: PREVENTION & CONTROL

Isolation precautions for patients Work restrictions for personnel Prophylaxis of patients and personnel Educate patients and personnel Screening tests postexposure Follow up

Secondary cases Delayed outbreak

SCREENING PROGRAMS

DECIDING TO SCREEN

Disease in local population Risk of significant exposure Cost of screening Implication of the screening results

WHEN TO SCREEN

Preemployment Medical history, immunization status Pregnancy, compromised immune status,

infectious disease Periodical

Changes in health status Illness during employment

Outbreak/Exposure Evaluation of susceptibility Type and duration of exposure Prophylaxis

WHAT TO DO AT A SCREENING

Medical history Health assessment Lab work TB screening Immunizations

This information is confidential!

COMMUNICABLE DISEASES TO SCREEN FOR

Tuberculosis (TB) Rubella OB & Pediatrics rubella, varicella, pertussis Blood/Body fluid exposures hepatitis B

TUBERCULOSIS

Includes essentially all healthcare personnel, even those entering patient or treatment rooms whether a patient is present or not. Full time, part time, PRN, contract

TB testing protocols based on TB risk assessment Recent exposures and/or conversions Community population

http://www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm

TB SCREENING METHODS

Purified protein derivative (PPD) skin testing Before employment and at intervals Two-step if no documented negative PPD within

past year Interpret according to CDC guidelines

QuantiFERON-TB (QFT) serum testing One-step, either + or -

Chest radiograph Risk factors identified New positive reactors (repeat at intervals)

History of symptoms Cough, weight loss, night sweats, etc

BLOODBORNE PATHOGENSexposure plan and immunization

OSHA REGULATIONS

Bloodborne Pathogen Act Develop an exposure plan Provide Hepatitis B vaccine within 10 days of

employment Training on potential hazards, PPE, engineering

controls and work practices (sharps safety) Must maintain sharps injury log

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

EXPOSURE PROCEDURES

1. Seek first aid (wash with soap & water, ER)2. Notify immediate supervisor3. Obtain baseline labs for HIV, Hepatitis B & C4. Follow requirements for consent to obtain

labs from source patient HIV, Hepatitis B & C

5. Document exposure ASAP per reporting methods

6. Follow up with occupational health for postexposure testing and counseling

POSTEXPOSURE COUNSELING

Risk of infection Signs and symptoms of infection Prophylaxis Testing Side effects of medications Interim precautions Risk reduction measures

RESPIRATORY PROTECTION PROGRAM

OSHA REGULATIONS

Program administrator required Fit test and seal check for respirator required

for each worker Employer must provide respirators, training,

and medical evaluations.

https://www.osha.gov/SLTC/respiratoryprotection/index.html

FIT TEST

Qualitative Pass/Fail Adequacy of fit

Quantitative Adequacy of fit Measures amount of leakage

Not required for PAPR (Powered air-purifying respirator)

WORK RESTRICTIONSactive infections and post-exposure

WORK RESTRICTIONS

List which illnesses and conditions should be reported to occupational health in policies and procedures Communicate this to personnel and

management Personnel who impose work restrictions should

have their authority written in P&P Restriction should no penalize the

personnel…or this will undermine reporting

DECIDING WORK RESTRICTIONS

Consider the following: Agent Mode of transmission Method of interruption of transmission Population at risk and susceptibility Educability and compliance of personnel Clinical status (signs & symptoms) Degree and type of patient and staff contact

Disease and symptom-specific guidance

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

CDC RECOMMENDATIONS

POST-EXPOSURE

DISEASES WITH NO POST-EXPOSURE TREATMENT

Herpes simplex Cytomegalovirus Meningitis other than N. meningitidis RSV Rotavirus Hepatitis C (Controversial)

POST-EXPOSURE: HEPATITIS C

Refer to specialist treatment controversial, there is no guideline

Exposure considered for HCV-positive source Baseline testing for anti-HCV and ALT May test in 4-6 weeks post-exposure for HCV

RNA if desired Retest in 4-6 months post-exposure for anti-

HCV and ALT

DISEASES WITH POST-EXPOSURE INTERVENTION

TB Evaluate and treat if symptomatic, no

prophylaxis Measles Meningitis (Neisseria meningitidis) Hepatitis A, B Varicella-zoster (Chickenpox) Scabies

Evaluate and treat if infested, no prophylaxis Pertussis HIV

POST-EXPOSURE: TB

Baseline skin testing Skin testing at 10 weeks after exposure

Positive conversion (≥5mm, if baseline was 0mm) Chest radiograph Laboratory tests (liver) Referral for medical evaluation

No change Consider retesting immunocompromised personnel

every 6 months

POST-EXPOSURE: MEASLES

Check immunization status If immunity is in question, check titers Administer vaccine if susceptible within 72

hours of exposure Exclude from duty 5 days after first exposure

to 21 days after last exposure

POST-EXPOSURE: MENINGITIS (NEISSERIA MENINGITIDIS)

Exposure considered for personnel with potential direct droplet contact (mouth-to-mouth, assisting intubation, endotracheal suctioning)

Prophylaxis immediately after exposure Ciprofloxacin oral (adults only, nonpregnant), Cefotaxime IM (children, pregnant), or Rifampin oral (children or adults)

POST-EXPOSURE: HEPATITIS B

Exposure considered if source is HbsAg positive or unknown

Perform baseline anti-HBs only if exposed person is vaccinated, but titers have not been checked

If unvaccinated, begin vaccine series at time of exposure and give HBIG (hepatitis B immune globulin) within 24 hours of exposure

POST-EXPOSURE: HIV

http://www.jstor.org/stable/pdfplus/10.1086/672271.pdf?acceptTC=true

Immediately test personnel and source for HIV-AB status

Baseline testing and follow up for 6 months 6 weeks, 3 months, and 6 months

Postexposure prophylaxis (PEP) and counseling ASAP, if source is HIV-negative stop PEP

Consult OB physician for pregnancy (not contraindicated but is complex)

IMMUNIZATIONS

VACCINE PREVENTABLE DISEASES

Hepatitis A and B Influenza Measles Mumps Rubella Tetanus and diphtheria Pertussis Polio Varicella-zoster (Chickenpox)

CDC RECOMMENDATIONS

http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html

PERFORMANCE IMPROVEMENT MEASURES