1 / 72

Occupational Health Update: Extended Care Facilities

Occupational Health Update: Extended Care Facilities. James J. Hill III, MD MPH FACOEM Associate Professor & Program Director Department of Physical Medicine & Rehabilitation University of North Carolina School of Medicine Medical Director, Occupational Health, UNC Chapel Hill

rozene
Download Presentation

Occupational Health Update: Extended Care Facilities

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Occupational Health Update:Extended Care Facilities James J. Hill III, MD MPH FACOEM Associate Professor & Program Director Department of Physical Medicine & Rehabilitation University of North Carolina School of Medicine Medical Director, Occupational Health, UNC Chapel Hill Associate Medical Director, Occupational Health, UNC Hospitals Diplomate, American Board of Physical Medicine & Rehabilitation Diplomate, American Board of Preventive Medicine/Occupational Medicine

  2. Goals • Understand occupational health services in a healthcare facility • Understand pre-exposure evaluation and vaccine-preventable disease for healthcare personnel • Understand post-exposure prophylaxis for occupational-acquired infectious diseases • Understand how to manage exposure to blood or potentially infectious material • Understand basic workplace accommodations in the setting of the ADA

  3. Disclosures • None

  4. Pneumococcal Vaccines

  5. Pneumococcal Vaccines • Polysaccharide vaccine (PPSV23) • Contains 23 different pneumococcal strains • FDA approved for all person > 50 years of age • FDA approved for high risk persons 19-64 years of age • One dose of PPSV23 is recommended for all adults aged 65 or older, regardless of previous vaccine history.* • Once a dose of PPSV23 has been given at age 65 or older, no additional doses of PPSV23 should be administered.

  6. Pneumococcal Vaccines • One dose of PPSV23 is recommended for adults 19-64 with certain medical conditions. • Once a dose of PPSV23 has been given at age 65 or older, no additional doses of PPSV23 should be administered. • A second PPSV23 vaccine should be given > 5 years after initial vaccine in adults 19-64 with one additional dose given when they turn 65

  7. Pneumococcal Vaccines • Conjugate vaccine (PCV13) • Contains 13 different pneumococcal strains • Conjugation with diphtheria toxin may improve immunogenicity • FDA approved for all person > 50 years of age • When indicated only a single dose is recommended for adults • One dose of PCV13 is recommended for all adults > 65 years of age unless they have already received the vaccine • If a patient needs both the PPSV23 and the PCV13, give the PCV13 first and the PPSV23 after > 8 weeks

  8. Pneumococcal Vaccines • https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf

  9. Occupational Health Services

  10. Health care facilities • Top five hazards (OSHA 2015) • Musculoskeletal Disorders related to patient or resident handling • Bloodborne Pathogens • Workplace Violence • Tuberculosis • Slips, Trips and Falls

  11. Health care facilities • Infections • Aerosol/droplet • Viral • Pertussis • Tuberculosis • Bloodborne pathogens • HIV • HBV • HCV • Contact • Syphilis • MRSA • Norovirus

  12. Health care facilities • Other hazards • Chemical • Solvents, cleaning supplies, medical gases • Radiation • Ionizing radiation, radioisotopes, lasers • Electrical • Workplace Violence • Stress • Shift work

  13. Workplace Safety • Goals • To provide a safe environment for patients and health care personnel (HCP) • To minimize risk of injury • To minimize risk of exposure to infectious disease • How? • Commitment to health and safety • Formal organized program to evaluate risks in the workplace • Formal organized program to provide effective, efficient care to the affected patient and/or HCP

  14. Traditional View of Workplace Safety

  15. Workplace Safety • Prevention is superior to treatment • A safe work environment reduces workplace costs while improving patient safety • The tools that we use for reducing occupationally acquired infections can also reduce the risk of injuries

  16. Occupational Health • Pre-employment screening • HCP-recommended vaccinations • Employment physical • Drugs/alcohol screening • Allergy screening (gloves) • Baseline TB testing • Fit test medical clearance • Hearing evaluation/audiogram • Fitness-for-duty • pregnancy, immunocompromised, security-sensitive

  17. Occupational Health • Annual • TB screening (facility and/or regulatory dependent) • Influenza vaccination • DOT/FMCSA drug/alcohol testing (facility dependent) • Policy development • Education • Wellness (facility dependent)

  18. Occupational Health • Event-driven • Communicable disease exposures • Blood-borne pathogens • Contact investigations • Acute injury • Infection Control • Ergonomic evaluation • Indoor air quality • For cause drug/alcohol testing • ADA/FMLA/Fitness-for-Duty

  19. OSHA State/Local Health Departments CDC/NIOSH Centers for Medicare Services DHHS Occupational Health Health Care Personnel Legal/Administration Worker’s Compensation Workplace Safety Infection Control

  20. Pre-exposure prophylaxis

  21. Vaccine Preventable Diseases • Anthrax • Diphtheria • HepatitisA/B/D • H. influenza type • Human papillomavirus (HPV) • Influenza A and B • Japanese encephalitis • Lyme disease • Measles • Monkeypox • Mumps • Rabies • Meningococcal A,C,Y,W135 • Meningococcal B • Pertussis • Pneumococcal • Poliomyelitis • Rotavirus • Rubella • Smallpox • Tetanus • Tuberculosis • Typhoid fever • Varicella(Zoster) • Yellow fever

  22. Why do I have to get vaccinated? • Vaccine-preventable diseases haven’t gone away. • Vaccination can mean the difference between life and death. • In the US, vaccine-preventable infections kill more individuals annually than HIV/AIDS, breast cancer, or traffic accidents. Approximately 50,000 adults die each year from vaccine-preventable diseases in the US. • Vaccines are safe and effective. • When you get sick, your children, grandchildren, and parents are at risk, too.

  23. I’ve heard that vaccines don’t work

  24. So, do I have to get vaccinated? • 10A NCAC 13D .2209 INFECTION CONTROL • (a) A facility shall establish and maintain an infection control program for the purpose of providing a safe, clean and comfortable environment and preventing the transmission of diseases and infection.

  25. I can’t get vaccinated, I’m ……. • Pregnant • Live-attenuated vaccines contraindicated (with some exceptions) • Immunocompromised • Case-dependent, concern is vaccine efficacy as well as patient safety • Allergic to eggs • Vaccine-dependent (may have egg-free formulations available) • On blood thinners • “Let me see your arm” • Afraid of needles • “Quick, look over there”

  26. I can’t get vaccinated, I’m ……. “Not willing to get vaccinated, despite all the things you have just told me ” ”Pick battles that are small enough to win, big enough to be important”

  27. Immunization documentation 1Consider immunization of HCP born before 1957, recommend during an outbreak; 2All HCP of childbearing potential should be immunized; 3requires lab confirmation; 4Obtain 1-6 months post last vaccine dose Weber DJ, Schaffner W. ICHE 2011;32:912-4

  28. Specific Vaccines

  29. Hepatitis B • Indications • Universal; HCP with potential blood exposure (OSHA required OR signed refusal) • Administration • Prior to administration do not routinely perform serologic screening for HB unless cost effective • After 3rd dose, test for immunity (>10 mIU/mL){OSHA required}; if inadequate provide 3 more doses and test again for immunity; if inadequate test consider as “non-responder” • If non-immune after 6 (or 3) doses, test for HBsAg

  30. OSHA mandate (1991) Estimated Incidence of HBV infections among HCP and General Population, United States, 1985-1999

  31. Influenza vaccines • Standard IM inactivate influenza vaccine (TIV) {> 6 months} • Inhaled live-attenuated influenza vaccine (LAIV) {ages 2-49} (NOT for 2016-2017 influenza season) • Other formulations • High titer influenza vaccine {>65 years} • Intradermal influenza vaccine {18-64 years} • Cell culture-based influenza vaccine^ {>18 years} (egg-free) • Two 2 quadrivalent influenza (2 A, 2 B strains) vaccines {>3} • Recombinant influenza (HA only) vaccine^ {18-49} (egg-free)

  32. Influenza vaccines • ACIP recommendations • 1 annual dose for all persons > 6 months of age • Required to be offered to residents and HCP in ECFs in NC • Immunize as soon as vaccine becomes available for the current season

  33. CDC National Summary 2016-2017 Season

  34. Measles, Mumps, Rubella (MMR) • Measles • Born before 1957: Consider immune (except during outbreak): Born after 1957: 2 doses • Immunity = Appropriate immunizations or positive serology • Mumps • Born before 1957: Consider immune (except during outbreak): Born after 1957: 2 doses • Immunity = Appropriate immunizations or positive serology • Rubella • 1 dose of MMR to susceptible women of childbearing potential • Immunity: Positive serology or documented vaccine

  35. Varicella • Special consideration should be given to those who have close contact with • persons at high risk for severe disease (e.g., immunocompromised persons) • persons are at high risk for exposure or transmission (e.g., teachers of young children, college students, military recruits, international travelers) • Immunity • birth before 1980 (not HCP or pregnant women), history of varicella or zoster by a HCP, positive serology, or laboratory evidence of infection

  36. Zoster Vaccine • One dose for persons > 60 years of age regardless of whether they had a prior episode of zoster • FDA approved for persons > 50 years of age - ACIP statement to be delayed (last update in 2014) • Live attenuated vaccine; avoid in immunocompromised persons

  37. Tetanus-diphtheria-acellular pertussis (/Tdap) • Substitute 1 dose Tdap for all adults when Td booster due • May be use to provide tetanus PEP • Provide to all adults with exposure to young children (no delay after Td) • Recommended for pregnant women (preferably 2nd or 3rd trimester) • Only one dose of Tdap is required, employees who are 10 years out from Tdap should be boosted with Td.

  38. Meningococcal Vaccine • Recommended for adults had high risk of disease (persistent complement deficiency, functional or anatomic asplenia, or HIV infection (adolescents)) • 2-dose primary series administered 2-months apart for persons aged 2-54 MCV4, • persons < 55 years; MPSV4 persons > 56 years

  39. Exposure Assessment

  40. Exposure Disease Dose Host

  41. Exposure Assessment • You have to be exposed to be at risk for the disease • ex. Blood on intact skin, limited time in patient room • The definition of exposure is agent-specific

  42. Exposure Assessment • Potentially infectious material • Contaminated fluids: blood, CSF, vaginal secretions, semen, synovial, pleural, peritoneal, pericardial, amniotic • Route of exposure • Percutaneous • Mucous membrane • Non-intact skin • Risk • HIV, HBV, HCV

  43. Exposure Assessment • Droplet • Sneezing (velocity 50 m/s; distance 6 m) • Coughing (velocity 10 m/s; distance 2 m) • Breathing (velocity 1 m/s; distance <1 m) • Route of exposure • Mucous membrane (hand-oral) • Non-intact skin • Risk • Influenza, adenovirus, RSV, pertussis, N. meningitides, group A streptococcus

  44. Exposure Assessment • Contact • Stool, draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids • Route of exposure • Mucous membrane (hand-oral) • Non-intact skin • Risk • norovirus, rotavirus, C. difficile, syphilis

  45. Exposure Assessment • Airborne • Route of exposure • Respiratory • Contact with infected fluid • Risk • TB, measles, chickenpox, disseminated zoster, zoster in immunocompromised patient

  46. Exposure Assessment • Exposure is agent-specific • Ex. Tuberculosis • Risk of TB infection is determined by duration of exposures (days to weeks, not minutes to hours) • Household contacts have different ventilation requirements related to air exchanges per hour • However, there is no ”safe time” to be exposed to TB

  47. Post-exposure prophylaxis

More Related