Employee/occupational health (10 questions)

1. APIC DFW Professional Advancement Employee/occupational health(10 questions) Preparing for the CBIC Test

2. Objectives • Review and/or develop screening and immunization programs • Provide counseling, follow-up, and work restriction recommendations related to communicable diseases 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 of occupational exposure to infectious diseases (e.g., tuberculosis, bloodborne pathogens)

3. Resources for study • Primary References: • 1. Grota P, ed. APIC Text of Infection Control and Epidemiology, 4th edition. Washington, DC: Association for Professionals in Infection Control and Epidemiology, 2014. Also available online at http://text.apic.org [subscription required]

4. Resources for study • Primary References (cont’d): • Notable Chapters • Bordatella pertussis • Herpes Virus • HIV/AIDS • Influenza • Measles, Mumps, Rubella • Neisseria meningitidis • Tuberculosis and Other Mycobacteria • Viral Hepatitis • Occupational Health • Occupational Exposure to Bloodborne Pathogens • Volunteers, Contract Workers, and Other Nonemployees Who Interact with Patients • Immunization of Healthcare Personnel • Pregnant Healthcare Personnel • Minimizing Exposure to Blood and Body Fluids

5. Resources for study • Primary References (cont’d): • 2. Brooks K. Ready Reference for Microbes, 3rd edition. Washington, DC: Association for Professionals in Infection Control and Epidemiology, 2012. • 3. Heymann D, ed. Control of Communicable Diseases Manual, 19th edition. Washington, DC: American Public Health Association, 2008

6. Resources for study • Primary References (cont’d): • 4. Kulich P, Taylor D, eds. The Infection Preventionist’s Guide to the Lab. Washington, DC: Association for Professionals in Infection Control and Epidemiology, 2012.

7. Resources for study • Secondary References: • ACIP. Vaccine Recommendations of the ACIP. Available at: http://www.cdc.gov/vaccines/acip/. • Current guidelines, standards, and recommendations from CDC, APIC, SHEA, and Public Health Agency of Canada • Pickering LK, ed. Red Book: Report of the Committee on Infectious Diseases, 29th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2012.

8. IP Objectives of an Employee Health Program • Educate personnel about the principles of infection prevention and their individual responsibility for infection prevention • Collaborate with the infection prevention department in monitoring and investigating potentially harmful infectious exposures and outbreaks. • Provide care to personnel for work-related illnesses or exposures. • Identify work-related infection risks and institute appropriate preventive measure. • Contain costs by preventing infectious diseases that result in absenteeism and disability

9. Major Components of an Occupational Health Program (OHP) • Administration • 1. Organizational issues • 2. Policies, procedures and protocols

10. Major Components of an Occupational Health Program (OHP) • Operational Issues • 1. Screening • 2. Education and counseling • 3. Occupational illness and injury treatment • 4. Nonoccupational illness treatment • 5. Preventive health services • 6. Environmental assessment and control • 7. Record keeping. The maintenance of OHP records, data management and confidentiality are required by federal, state and local standards; copies of individual records are to be made available to the worker upon request.

11. Major Components of an Occupational Health Program (OHP) • Communication Between the IP and Personnel in the OHP • 1. Share information related to: • a. Healthcare worker exposure to communicable diseases • b. Healthcare worker infections • c. Community and personnel outbreaks • d. Development of policies and procedure for occupational health • e. Educational programs for healthcare workers.

12. Major Components of an Occupational Health Program (OHP) • Occupational Health Professional • 1. Coordinates and performs the activities of the OHP • E. Medical Advisor or Consultant • 1. Collaborates in the development of protocols • 2. Serves as a resource to the occupational health professional when needed in assessing, screening or treating healthcare workers. • Healthcare Personnel • CDC defines the term healthcare personnel as 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 contained air.

13. Major Components of an Occupational Health Program (OHP) • Policies and Procedures Needed to Implement an Effective OHP • 1. Work restrictions • 2. Criteria for disease exposure and prophylaxis • 3. Screening procedures • 4. Illness reporting system • 5. Methods of detecting, preventing and controlling disease • 6. Protocols for treatment of occupational injuries and illnesses • 7. Protocols for treatment of non-occupational illness

14. Major Components of an Occupational Health Program (OHP) • Screening for Disease Detection, Prevention and Control • 1. Determined by • a. Incidence of disease in local population • b. Risk of significant exposure in healthcare workers’ work- related activities • c. Cost of screening • d. Implications of the results of screening • 2. Purposes of screening • 3. Components of OHP screening • 4. Communicable Disease screening by OHP • 5. Employee illness/injury treatment • 6. Preventive health services • 7. Environmental assessment and intervention • 8. Occupational health records– confidential unless release form is signed

15. Major Components of an Occupational Health Program (OHP) • Transmission of Infection to and from the Healthcare Worker • 1. Vaccine preventable diseases • 2. Diseases with post-exposure intervention • 3. Diseases with no post-exposure intervention • 4. Work restrictions related to communicable disease

16. Major Components of an Occupational Health Program (OHP) • Education • 1. New healthcare worker employee orientation • 2. Annual healthcare worker updates • 3. Post-exposure counseling • 4. HIV/AIDS, hepatitis B or C exposure counseling • 5. TB exposure testing recommendations and positive skin test conversions • 6. Workers’ compensation issues • 7. Pregnant worker concerns • 8. Community-acquired infections– non-work-related • 9. Influenza prevention • 10. Measles, mumps, rubella and chickenpox protection and prevention • 11. Laboratory, radiology and cardiology results and analysis of testing done by OHP • 12. Employee illness guidelines related to fever, respiratory illness, draining lesions, diarrhea, etc.

17. Major Components of an Occupational Health Program (OHP) • Plan of Action for Detection, Prevention and Control of Diseases That Are a Threat to Healthcare Workers • 1. Detection • a. History of disease • b. Symptoms • c. Laboratory studies • d. Reporting of cases to health department • 2. Prevention and control • a. Isolation precautions for patients • b. Work restrictions for employees • c. Appropriate barrier treatment • d. Prophylaxis of patient and healthcare workers • e. Education for healthcare worker and patient • f. Screening tests post-exposure • g. Follow-up to determine secondary cases or delayed outbreak

18. Major Components of an Occupational Health Program (OHP) • Occupational Blood or Body Fluid Exposure Management (pg 250) • Respiratory Protection Program • Occupational Health Hazards: Post-exposure Interventions • Guidelines for Work Restrictions for Employees with Infectious Diseases • Immunizations Recommended for Healthcare Workers (pg 258-264) • Performance Improvement in Preventing Occupational Exposure

19. Questions??? • Cheryl Sharp • 817-965-1561 (Cell) • 817-848-4068 (Work) • Cheryl.Sharp@TexasHealth.org Jerry Kelley 817-705-7822 (Cell) 817-255-1899 (Work) Gerard.Kelley@hcahealthcare.com Infection Prevention Competency Review Guide- 4th & 5th Editions, Carol McLay, DrPH, MPH, RN, CIC