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Occupational Health Employee Health for the IP

Occupational Health Employee Health for the IP. Reasons for developing an Employee Health Program Elements of an Employee Health Program Transmission of infection to and from the health care personnel. Key Concepts. Key Concepts.

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Occupational Health Employee Health for the IP

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  1. Occupational Health Employee Healthfor the IP

  2. Reasons for developing an Employee Health Program Elements of an Employee Health Program Transmission of infection to and from the health care personnel Key Concepts

  3. Key Concepts • Common infectious processes with indications for post exposure intervention • Work restrictions in the healthcare facility

  4. Key Concepts • Worker’s Compensation • Measuring improvement in preventing occupational exposure

  5. Providing a safe environment Double-edged sword: Staff and Patients Increased awareness during the past three decades related to the AIDS epidemic Background

  6. Background • Regulatory Compliance: OSHA (Occupational Safety and Health Administration) • Organizational Resources and recommended practices: IPs are called on to provide credible references to support the policies and practices that are in place

  7. IP policies, procedures, and practices in an Occupational Health program are designed to interrupt the transmission of infection to and from the healthcare personnel Basic Principles

  8. Principle to Process • Some pose a threat and have vaccines for prevention • Some require post exposure follow-up • Some have no indications for follow-up

  9. HCP Health Care Personnel

  10. All paid and unpaid persons (i.e. volunteers, lay chaplains) 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. HCP: A Definition

  11. Communication with other departments is vital Proper isolation of contagion by nursing staff Reporting exposures Proper identification of employee with contagion Design of an OH/EH Program

  12. Pre-employment physical exams have not been demonstrated to be cost effective Medical evaluations performed before placement might identify worker risk for infection and whose placement may need to be considered carefully Periodic evaluations may need to be performed for job assignments or work related problems Design

  13. Staff education may contribute to workers’ compliance with IP practices through understanding of rationale (Why we do the things we do?) Existing federal, state, and local regulations for staff education and training Management of job related illnesses, exposures and post-exposure follow up is mandated by regulatory agencies Design

  14. Work restrictions may be indicated for workers who have transmissible illnesses. The facility should have a process in place to identify who has the authority to remove the worker from duty Maintenance of records, data management, and confidentiality are major requirements of OH/EH programs Know who can have access to HCP files Separate HR file from EH file. Design

  15. Design • Health counseling should be available about occupational and community infection risks

  16. Immunization Programs • Recommended immunization practices are addressed by the US Public Health Service’s Advisory Committee on Immunization Practices (ACIP) • Hepatitis B • Influenza • MMR • Varicella • Pertussis • Tdap • VIS (Vaccine information sheets from CDC)

  17. Resources • MMWR; November 25, 2011 Immunization of Health-care Personnel • APIC Text. 4th Edition, Chapter 103

  18. Hepatitis B

  19. Influenza (reportable to NHSN)

  20. Mumps, Measles, Rubella

  21. Varicella

  22. Tetanus diphtheria acellular pertussis Tdap

  23. Meningococcal References 1. CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 2011; 60(RR-7).

  24. Texas Senate Bill 7 • Vaccine Preventable Disease Policy Required • Based on level of risk • Must specify vaccines required • Includes procedures for verification of compliance

  25. and more • Includes procedures for HCP to be exempt for medical/religious reasons • Includes procedures for exempt employees based on employees level of risk • Includes disciplinary actions for employees who fail to comply with procedure

  26. Meningitis Neisseria meningitidis H. flu TB Baseline PPD or IGRA and again at 12 weeks after exposure Varicella Days 10-21 post exposure Post Exposure Management

  27. Post Exposure Management • Pertussis • Within 21 days post exposure to asymptomatic contacts • Incubation 7 – 10 days • Blood borne Pathogens • OSHA • CDC / PEP Line • APIC Text

  28. Index case- verify the diagnosis Is the patient infectious? Yes No Was barrier protection absent or breached? No action Yes No Identify exposed individuals No action Isindividualsusceptible? No Yes Does disease have potential for further spread? No action No Yes Do therapeutic measures for treatment exist? Yes No Monitor employee for symptoms/work restrictions Implement intervention measures

  29. CDC published recommendations for controlling the spread of TB in healthcare facilities OSHA has a compliance directive addressing occupational exposure to TB OSHA’s General Duty Clause requires each employer to provide it’s employees a place of employment free from recognized hazards Tuberculosis

  30. QuantiFERON Gold (blood test) IGRA T-Spot another blood test If using PPD skin testing, 2 step is mandatory for ALL employees Job description makes NO difference Fit testing a MUST for those with patient contact. Check OSHA risk in job description. TB evaluation of NEW employees

  31. EVERY employee must have an annual evaluation. Depends on job description. Do they have patient contact? Sign a statement stating they have NO CONTACT. Or do IGRA/TST/ PPDQ (questionnaire) if +. Annual TB evaluation

  32. Annual TB evaluation • TB conversion – do CXR and send for treatment. (Health department) • Document treatment in Employee file.

  33. Employee fit testing for N-95 respirator OSHA requires fit testing

  34. Quantitative Fit Test (QNFT) Protocols Ambient aerosol condensation nuclei counter (CNC) quantitative fit testing protocol (Porta count TM ) Fit testing Procedures

  35. Technique Matters !

  36. Technique

  37. Measure induration only not the redness.

  38. Documented occupational exposure to confirmed Pertussis case If macrolide tolerant If macrolide intolerant Azithromycin 600 mg/day orally for five (5) days TMP-SMX 320/1600 mg /day in two divided doses orally for fourteen (14) days Protocol for Occupational Exposure to Pertussis Supplement A

  39. VARICELLA EVALUATION All new hires Positive history of chicken pox OR Positive history of vaccination Unknown history of chicken pox OR Negative or unknown history of vaccination Consider non-immune Consider immune Draw VZIG If positive, consider immune If negative, offer vaccine

  40. Staff Exposed to Varicella Report to Staff Health & Safety (Occupational or Community Exposure) History of Varicella Vaccinated or unknown history Negative VZIG Draw VZIG Consider immune Positive Offer vaccine if within 72 hrs or VZIG within 96 hrs Consider non-immune • Mask employee days 10-21 • Self assessment daily for symptoms • Notify Health Staff if symptoms • appear Staff Health to verify as Varicella (IgM, IgG and vesicle culture for VZV)

  41. Defining Exposure

  42. Determine HIV status of patient & employee (rapid testing if possible) Determine HEP B status of patient & employee (check employee HBAB) Determine HEP C status of patient & employee Reportable in the OSHA log 300 BBP Exposure

  43. If all patient labs are negative nothing further need be done. If positive, offer PEP, vaccines, and follow-up lab work. If no patient is identified continue with follow-up lab work. No PEP is needed. BBP exposure Follow-Up

  44. Work Restrictions www.cdc.gov APIC Text of Infection Control and Epidemiology Post Exposure Interventions

  45. IP may be asked to help assess situation to determine if a worker has experienced occupational acquisition of infectious agent or disease Workman’s comp programs vary from state to state. TX is under Insurance division. Division of Worker’s Compensation(DWC). Workman’s Compensation

  46. Workman’s Compensation • Components may include medical benefits, weekly compensation, safety and rehab programs • Eligible if occupational exposure is sole cause of the disease or accident • Burden of proof lies with the workers

  47. Workman’s Compensation • Most states don’t provide compensation for a disease that is an ordinary disease of life • Stroke • Heart attack • TB – W/C in Texas must be able to attach employee to actual patient diagnosed with active TB

  48. Epidemiologic approach can be taken to manage occupational exposures Reductions or increases in injuries or exposures are monitored over time Causes can be identified Variations are analyzed Prevention strategies are designed and implemented Measuring Improvement in Occupational Exposure Prevention

  49. Average daily census of occupied beds for the year can be used as denominator Total number of needle sticks reported in one year Divided by the total number of occupied beds in one year Equals the number of needle sticks per bed per year Benchmarks are available from the AOHP Rates measuring performance

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