EMPLOYEE HEALTH TABLE OF CONTENTS

EMPLOYEE HEALTH TABLE OF CONTENTS PHYSICAL ASSESSMENT.2 REPORTING EMPLOYEE INFECTIONS...3 SUMMARY OF IMPORTANT RECOMMENDATIONS AND WORK RESTRICTIONS FOR PERSONNEL WITH INFECTIOUS DISEASES.4 HEPATITIS B IMMUNIZATION PROGRAM 8 POLICY FOR HEPATITIS B VACCINE..9 POST-EXPOSURE EVALUATION AND FOLLOW-UP...10 YCS Exposure Incident Report..12 BLOODBORNE PATHOGENS POST-EXPOSURE..16 RECOMMENDATIONS FOR HEPATITIS B PROPHYLAXIS.... 17 POTENTIAL HIV EXPOSURE 18 VACCINE RECOMMENDATIONS 19 Revised 9/2007 1

PHYSICAL ASSESSMENT PURPOSE: A physical examination is required for all staff to insure that staff is physically fit to perform the essential functions of the job and to determine that they are free of communicable diseases. POLICY: 1. New employees should complete a physical assessment prior to reporting to work. They must bring the signed physician's or other designated health professional s statement before they will be permitted to work. The form will be provided by the employer. 2. All employees, volunteers, interns, or students must have a completed physical exam upon hiring. A previous physical exam within six months prior to starting employment at YCS will be acceptable. A copy of the report must be placed in the employee s personnel file. 3. If at any time during employment, a physician indicates that an employee is unable to perform the essential functions of the job, or if there is reason to suspect the employee is putting others at risk due to a communicable disease, the employee will not be permitted to work in that position until further evaluation and clearance to work by a physician is obtained. Revised 9/2007 2

REPORTING EMPLOYEE INFECTIONS PURPOSE: To insure identification and follow-up of infections among employees, therefore minimizing the risk of transmission to others. POLICY: 1. Any employee having an infection is responsible for reporting it to their supervisor, who will report it to the Nurse. 2. The Nurse is responsible for completing and maintaining the employee infection record whenever an infection is reported. 3. The Nurse will follow the agency s policy on work restrictions for communicable diseases. Refer to Summary of Important Recommendations and Work Restrictions for Personnel with Infectious Diseases in this section for reference. However, the policy of obtaining a written clearance to return to work from a physician supersedes the recommendations. Work restrictions will be determined on an individual basis. 4. OSHA logs are maintained by the Human Resources Department. 5. Annual compilation of all illnesses and injury data is completed by the Human Resource Department. Revised 9/2007 3

SUMMARY OF IMPORTANT RECOMMENDATIONS AND WORK RESTRICTIONS FOR PERSONNEL WITH INFECTIOUS DISEASES DISEASE/PROBLEM WORK RESTRICTIONS DURATION Conjunctivitis Cytomegalovirus infection (CMV) Diarrheal diseases Acute stage (diarrhea with other symptoms) Restrict from patient contact and contact with the patient s environment No restrictions Restrict from care of high-risk patients Until discharge ceases Until symptoms resolve; consult with local and state health authorities regarding need for negative stool cultures Convalescent stage, Restrict from patient contact, contact Until antimicrobial therapy Salmonella sp. with the patient s environment, or food completed and 2 cultures handling obtained >24 hours apart are negative Diphtheria Exclude from duty Until symptoms resolve Enteroviral infections Hepatitis A Hepatitis B Personnel with acute or chronic hepatitis B surface antigenemia who do not perform exposureprone procedures Restrict from care of infants, neonates, and immunocompromised patients and their environments Restrict from patient contact, contact with patient s environment, and food handling No restriction unless epidemiologically linked to transmission of infection; refer to state regulations; standard precautions should always be observed Until symptoms resolve Until 7 days after onset of jaundice Personnel with acute or chronic hepatitis B e antigenemia who perform exposure-prone procedures Do not perform exposure-prone invasive procedures until counsel from an expert review panel has been sought; panel should review and recommend procedures the worker can perform, taking into account specific procedure as well as skill and technique of worker; refer to state regulations Until hepatitis B e antigen is negative Revised 9/2007 4

Summary Of Important Recommendations And Work Restrictions For Personnel With Infectious Diseases (continued) DISEASE/PROBLEM WORK RESTRICTIONS DURATION Hepatitis C Herpes simplex Genital Hands (herpetic whitlow) Orofacial Human immunodeficiency virus Measles No recommendation No restriction Restrict from patient contact and contact with the patient s environment Evaluate for need to restrict from care of high-risk patients Do not perform exposure-prone invasive procedures until counsel from an expert review panel has been sought; panel should review and recommend procedures the worker can perform, taking into account specific procedure as well as skill and technique of the worker; standard precautions should always be observed; refer to state regulations Until lesions heal Active Exclude from duty Until 7 days after the rash appears Postexposure (susceptible personnel) Exclude from duty For 5 th day after 1 st exposure through 21 st day after last exposure and/or 4 days after rash appears Meningococcal infections Exclude from duty Until 24 hours after start of effective therapy Mumps Active Exclude from duty Until 9 days after onset of parotitis Postexposure (susceptible personnel) Exclude from duty From the 12 th day after 1 st exposure through 26 th day after last exposure or until 9 days after onset of parotitis Pediculosis Restrict from patient contact Until treated and observed to be free of adult and immature lice Revised 9/2007 5

Summary Of Important Recommendations And Work Restrictions For Personnel With Infectious Diseases (continued) DISEASE/PROBLEM WORK RESTRICTIONS DURATION Pertussis Active Exclude from duty From beginning of catarrhal stage through 3 rd week after onset of paroxysms or until 5 days after start of effective antimicrobial therapy Postexposure (asymptomatic personnel) Postexposure (symptomatic personnel) No restriction, prophylaxis recommended Exclude from duty Until 5 days after start of effective antimicrobial therapy Rubella Active Exclude from duty Until 5 days after rash appears Postexposure (susceptible personnel) Exclude from duty From 7 th day after 1 st exposure through 21 st day after last exposure Scabies Restrict from patient contact Until cleared by medical evaluation Staphylococcus aureus infection Active, draining skin lesions Carrier state Streptococcal infection, group A Restrict from contact with patients and patient s environment or food handling No restriction, unless personnel are epidemiologically linked to transmission of the organism Restrict from patient care, contact with patient s environment, or food handling Until lesions have resolved Until 24 hours after adequate treatment started Tuberculosis Active disease Exclude from duty Until proved noninfectious TST converter No restriction Varicella Active Exclude from duty Until all lesions dry and crust Postexposure (susceptible personnel) Exclude from duty From 10 th day after 1 st exposure through 21 st day (28 th day if VZIG given) after last exposure Revised 9/2007 6

Summary Of Important Recommendations And Work Restrictions For Personnel With Infectious Diseases (continued) DISEASE/PROBLEM WORK RESTRICTIONS DURATION Viral Respiratory Infections Acute febrile (temperature 38 degrees Celsius or above) Zoster Localized, in healthy person Exclude from duty Cover lesions; restrict from care of high-risk patients (Those susceptible to varicella and who are at increased risk of complications of varicella, such as neonates and immunocompromised persons of any age) Respiratory Etiquette until acute symptoms resolve Until all lesions dry and crust Generalized or localized in immunosuppressed person Postexposure (Susceptible personnel) Viral respiratory infections, acute febrile Restrict from patient contact Restrict from patient contact Consider excluding from the care of high risk patients (high-risk patients as defined by the ACIP for complications of influenza) or contact with their environment during community outbreak of RSV and influenza Until all lesions dry and crust From 10 th day after 1 st exposure through 21 st day (28 th day if VZIG given) after last exposure or, if varicella occurs, until all lesions dry and crust Until acute symptoms resolve Adapted from CDC Guideline for Infection Control in Hospital Personnel, 1998 Revised 9/2007 7

HEPATITIS B IMMUNIZATION PROGRAM PURPOSE: To establish guidelines for employee screening for Hepatitis B immunity and vaccine administration. POLICY: 1. All YCS employees will be offered the Hepatitis B Vaccine free of cost. 2. Following a review of the disease and vaccine information, the employee will sign consent to receive the vaccine. (See "Information on Hepatitis B and the Vaccine".) 3. If an employee declines immunization, he/she will sign a statement to that effect (Refer to Section 5, Page 9 for the Policy for Hepatitis B Vaccine Form). The signed Policy for Hepatitis B Vaccine Form will be kept in the employee s record in the Human Resource Department. If the employee chooses to be immunized in the future, this procedure will be followed. 4. Three IM doses of vaccine will be given - the initial dose, at one month and at six months. The vaccine will be administered deep intramuscular in the deltoid muscle. 5. Should an exposure occur, the post-exposure algorithm will be followed. Revised 9/2007 8

POLICY FOR HEPATITIS B VACCINE The following statement regarding the Hepatitis B vaccination must be signed by all employees. The statement can only be signed by the employee following appropriate training regarding Hepatitis B vaccination, the efficacy, safety, method of administration and benefits of vaccination, and that the vaccine and vaccination are provided free of charge to the employee. I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring Hepatitis B virus (HBV) infection. The statement is not a waiver; employees can request and receive the Hepatitis B vaccination at a later date if they remain occupationally at risk for Hepatitis B. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. I decline the Hepatitis B vaccination at this time. I wish to receive the Hepatitis B vaccination. Employee Signature / / Date Print Name Witness / / Date Revised 9/2007 9

POST-EXPOSURE EVALUATION AND FOLLOW UP 1. Should a possible exposure to bloodborne pathogens occur, the Nurse Manager or Program Administrator/Director should be contacted. 2. Initial first aid and follow-up will be conducted by the site/program nurse. Following the initial first aid (clean the wound, flush eyes, or other mucous membrane, etc.), the following activities will be performed: Complete the YCS Exposure Incident Report. Document the route of exposure and how the exposure occurred. Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV and HBV infectivity. If the source individual is already known to be HIV, HCV and/or HBV positive, new testing need not be performed. Assure that the exposed employee is provided with the source individual s test results and with information about applicable disclosure laws and regulations concerning the identity and infectious state of the source individual (e.g., laws protecting confidentiality). Inform employee that post-exposure prophylaxis is most effective if initiated within 24 hours of exposure from HIV. Arrangements for immediate evaluation at the nearest contracting facility or emergency room should be made within a 24 hour time frame if deemed necessary. After obtaining consent, collect exposed employee s blood as soon as feasible after the exposure incident, and test blood for HBV and HIV serological status, antibody to Hepatitis C, and ALT. If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed employee elects to have the baseline sample testing during this waiting period, perform testing as soon as feasible. Employee who has suffered an incident of exposure will receive all medical evaluations, procedures, tests, and prophylaxis at no cost. The employee should be advised to seek medical attention for any illness that occurs within twelve weeks of exposure and should be provided counseling and medical Revised 9/2007 10

evaluation of reported illnesses. Following an exposure incident, the agency (YCS) will provide to the employee: a) Referral of employee b) A copy of the OSHA standard on bloodborne pathogens. c) A description of the exposed employee's duties as they relate to the exposure incident. d) Documentation of the route of exposure and circumstances under which exposure occurred. e) Results of the source individual's blood testing. f) Relevant medical records including vaccination status. Within fifteen days after evaluation of the exposed employee, YCS will provide the employee with a copy of the health care professional s written opinion. The written opinion is limited to whether the vaccine is indicated and if it has been received. The written opinion for post-exposure evaluation must document that the employee has been informed of the results of the medical evaluation and of any medical conditions resulting from the exposure incident that may require further evaluation or treatment. All other diagnoses must remain confidential and not be included in the written report. Revised 9/2007 11

YCS Exposure Incident Report NOTE: The information on this form is confidential and shall not be released without written permission of the source patient and employee. 1. The licensed nurse or supervisor shall initiate an exposure incident report, answering all applicable questions. 2. The completed Exposure Incident Report shall be forwarded to the Vice-President of Health Services. Revised 9/2007 12

YCS EXPOSURE INCIDENT REPORT (Routes and Circumstances of Exposure Incident) Please Print Date Completed: Employee s Name: SS#: Home Phone: Business Phone: DOB: Job Title: Employee Vaccination Status: Date of Exposure: Time of Exposure: AM PM Location of Incident (Home, Street, Clinic, etc. Be Specific): Nature of Incident (Auto Accident, Trauma, Medical Emergency, etc. Be Specific): Describe What Task (s) You Were Performing When The Exposure Occurred (Be Specific): Were You Wearing Personal Protective Equipment (PPE)? YES NO If Yes, List: Did The PPE Fail? YES NO If YES, Explain How: What Body Fluid(s) Were You Exposed To? (Blood or Other Potentially Infectious Material Be Specific): Revised 9/2007 13

What Parts Of Your Body Became Exposed? (Be Specific): Estimate The Size OF The Area Of Your Body That Was Exposed: For How Long? Did A Foreign Body (Needle, Nail, Auto Part, Dental Wire, etc.) Penetrate Your Body? YES NO If YES, What Was The Object? Where Did It Penetrate Your Body? Was Any Fluid Injected Into Your Body? YES NO If YES, What Fluid? How Much? Did You Receive Medical Attention? YES NO If YES, Where? When? By Whom? Revised 9/2007 14

Identification of Source Individual(s): Name(s) Did You Treat The Patient Directly? YES NO If YES, What Treatment Did You Provide? (Be Specific): Other Pertinent Information: Signature of Employee: Date: Signature of Health Care Professional: Date: (6/02) Revised 9/2007 15

BLOODBORNE PATHOGENS POST-EXPOSURE EVALUATION/HEALTHCARE PROFESSIONAL'S WRITTEN OPINION NOTE: Prior to the evaluation, the healthcare professional will be provided: a) A copy of the OSHA standard on bloodborne pathogens. b) A description of the exposed employee's duties as they relate to the exposure incident. c) Documentation of the route of exposure and circumstances under which exposure occurred. d) Results of the source individual's blood testing. e) Relevant medical records including vaccination status. WRITTEN OPINION I have assessed on employee date for an exposure incident which occurred on. date I have a copy of the Updated 2001 OSHA standard, the "YCS Exposure Incident Report" form from the employer and a copy of the 1998 USPHS Recommendations for Hepatitis B Prophylaxis Following Percutaneous or Permucosal Exposure. I. HEPATITIS B IMMUNIZATION (Check one) Hepatitis B prophylaxis is Hepatitis B prophylaxis is not indicated. indicated. II. POST EXPOSURE EVALUATION AND FOLLOW-UP (Check all that apply) The employee has been informed of the results of my evaluation. The employee has been informed of any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. Signature of Healthcare Professional Date Signature of Exposed Employee Date Witness of Employee's Signature Date This form or a prescription from the evaluating physician must be received by the employer and a copy provided to the employee within 15 days of the evaluation. Revised 9/2007 16

Recommendations for Hepatitis B Prophylaxis Following Percutaneous or Permucosal Exposure Treatment when source is found to be: Exposed Person Unvaccinated HBsAg Positive HBIG x 1* and initiate HB vaccine series HBsAg Negative Initiate HB vaccine series Source not tested or unknown Initiate HB vaccine series Vaccinated: KNOWN RESPONDER Known nonresponder Vaccinated: No treatment No treatment No treatment HBIG x 1 and initiate revaccination or HBIG x 2 No treatment If known high risk source, treat as if source were HBsAg positive Response unknown Test exposed for anti- HBs: No treatment Test exposed for anti-hbs: 1. If adequate, no treatment 2. If inadequate, ** HBIG x 1 and vaccine booster 1. If adequate, no treatment 2. If inadequate, administer vaccine booster and recheck titer in 1-2 months * Hepatitis B Immune Globulin (0.6 ml/kg IM) ** Adequate anti-hbs is > 10 mlu/ml Reference: Recommended postexposure prophylaxis for exposure to hepatitis B virus, MMWR, June 29, 2001. Revised 9/2007 17

POTENTIAL HIV EXPOSURE TYPE OF EXPOSURE Parenteral Mucous Membrane: Skin: Needlestick Cut Bite Splash to eye, mouth, or nose from blood or other potentially infectious materials Non-intact cutaneous exposure to blood and/or other potentially infectious materials SOURCE PATIENT Positive Source or Refuses Testing or Negative Source 1. Initial test 2. Discontinue employee follow-up unless further testing is requested by exposed employee. Unknown Source Exposed individuals: 1. Pre and Post Counseling 2. Signed Consent Forms 3. HIV antibody testing * immediately * six weeks * three months * six months after exposure 4. NOTE: Extended HIV follow-up for 12 months is recommended for HCPs who become infected with HCV after exposure to a source co-infected with HIV and HCV. 5. NOTE: The most recent recommendations for HIV exposure are very complex with a variety of choices for post-exposure prophylaxis. Therefore, the reader is referred to the current recommendations for HIV exposure found in the MMWR, VOL. 54(RR09); 1-17, Sept. 30, 2005. It can be accessed via the CDC web site: www.cdc.gov. Post-exposure prophylaxis is most effective when initiated within 24 hours of HIV exposure. Revised 9/2007 18

VACCINE RECOMMENDATIONS Recommended Immunization Schedule for Healthcare Workers Vaccine Hepatitis B Indication All employees with potential risk of exposure to blood and/or body fluids Influenza All employees with contact with high risk clients or working in chronic care facilities MMR Measles Adults born after 1957 without a history of physician-diagnosed measles, serologic immunity, or documentation of having received two doses of vaccine after their 1 st birthday. Mumps Rubella Adults born after 1957 without a history of mumps, serologic immunity, or documentation of having received vaccine. All employees, both male and female, born after 1957 without a history of serologic immunity or documentation of receipt of vaccine after their 1 st birthday. Varicella Non-immune employees who have client contact. Employees are encouraged to consult with a private physician prior to receiving any of the above recommended vaccines. Reference: Bolyard, E.A., Tablan, O.C., Williams, W.W., et.al. Guideline for Infection Control in Health Care Personnel, 1998. Hospital Infection Control Practices Advisory Committee. Amer. J.Infection Control, 26(3):289-354,1998. Revised 9/2007 19