Objectives (10 Questions)

4. 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)

5. Employee/Occupational Health Programs

6. 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

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

8. Communication with IP • Personnel exposure • Personnel infections • Community and personnel outbreaks • Policies and procedures • Educational programs for personnel

9. 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

10. 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

11. 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

12. Action Plan: Detection • History of disease • Symptoms • Labs • Reporting cases to health department

13. 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

14. Screening Programs

15. Deciding to screen • Disease in local population • Risk of significant exposure • Cost of screening • Implication of the screening results

16. 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

17. What to do at a screening • Medical history • Health assessment • Lab work • TB screening • Immunizations This information is confidential!

18. Communicable diseases to screen for • Tuberculosis (TB) • Rubella • OB & Pediatrics  rubella, varicella, pertussis • Blood/Body fluid exposures  hepatitis B

19. 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

20. 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

21. Bloodborne pathogens exposure plan and immunization

22. 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

23. Exposure procedures • Seek first aid (wash with soap & water, ER) • Notify immediate supervisor • Obtain baseline labs for HIV, Hepatitis B & C • Follow requirements for consent to obtain labs from source patient HIV, Hepatitis B & C • Document exposure ASAP per reporting methods • Follow up with occupational health for postexposure testing and counseling

24. Postexposure counseling • Risk of infection • Signs and symptoms of infection • Prophylaxis • Testing • Side effects of medications • Interim precautions • Risk reduction measures

25. Respiratory protection Program

26. 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

27. Fit test • Qualitative • Pass/Fail • Adequacy of fit • Quantitative • Adequacy of fit • Measures amount of leakage • Not required for PAPR (Powered air-purifying respirator)

28. Work Restrictions active infections and post-exposure

29. 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

30. 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

31. CDC Recommendations • Disease and symptom-specific guidance http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

32. Post-exposure

33. Diseases with NO post-exposure treatment • Herpes simplex • Cytomegalovirus • Meningitis other than N. meningitidis • RSV • Rotavirus • Hepatitis C (Controversial)

34. 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

35. 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

36. 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

37. 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

38. 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)

39. 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

40. Post-exposure: HIV • 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) http://www.jstor.org/stable/pdfplus/10.1086/672271.pdf?acceptTC=true

41. Immunizations

42. Vaccine preventable diseases • Hepatitis A and B • Influenza • Measles • Mumps • Rubella • Tetanus and diphtheria • Pertussis • Polio • Varicella-zoster (Chickenpox)

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

44. Performance Improvement Measures