EMPLOYEE HEALTH
Employee Health: Screening and immunization programs Counseling, follow up work restrictions Analysis and trending of occupational exposure incidents Assess risk for occupational exposure to infectious diseases (e.g., TB, blood borne pathogens)
Healthcare Professionals Responsibilities Education Collaboration Provide care Identify work-related infection risks Preventive measures. Contain costs
Operational Issues Screening Education and counseling Occupational illness and injury treatment Non-occupational illness treatment Preventive health services Environmental assessment and control Record keeping
Communication Between IP and OHP HCW exposure to communicable disease HCW infections Community and personnel outbreaks Develop P&Ps for OH HCW education programs
Organizational Chart Occupational Health Professional Medical Advisor or Consultant Healthcare Personnel CDC definition: all paid and unpaid persons working in healthcare settings who have potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air. Health Canada s Center: any individuals who have potential to acquire or transmit infectious agents during the course of his/her own work in healthcare.
Includes: Nurses Nursing assistants Physicians Technicians Therapists Laboratory personnel Autopsy personnel Researchers Pharmacists Students Contractual staff not employed by facility Emergency medical service personnel Dental personnel Volunteers Clerical Dietary & maintenance personnel
Policies and Procedures Needed for an Effective OHP: Work restrictions Disease exposure and prophylaxis Screening procedures Illness reporting system Methods to detect, prevent, and control disease Protocols for treatment of occupational injuries and illnesses Protocols for treatment of non-occupational illness
Screening for Disease and Detection, Prevention and Control Determined by: Incidence of disease in local population Risk of HCW exposure Cost Implication of results of screening
Screening Purposes of screening: Components of screening: Communicable Disease Screening: Employee Illness/Injury Treatment:
Education and Intervention Preventive Health Services: Give me two examples Name one common service that is provided to the public* Environmental Assessment and Intervention Evaluate Assess Determine high risk areas for specific disease (e.g., blood exposures)
Occupational Health Records: Communicable disease history Immunization status, if determined by serological testing Immunization record Records of exposure to disease and any prophylaxis
Education Transmission of infection: Vaccine preventable diseases Diseases with post exposure intervention Diseases with no post exposure intervention Work restrictions Education: New employee orientation Annual employee education post exposure counseling
Interventions Threat Plan of Action Detection Prevention and Control Types of isolation precautions needed Blood or body fluid exposure management Policies and procedures Education and training Rapid access to clinical care Injury assessment
Exposures Exposure Procedures Seek first aid and notify supervisor Baseline labs Complete required paperwork Post injury counseling by OHP Risk of infection, signs of infection, prophylaxis, etc. OSHA Respiratory Protection Program (N95) Employer provides respirators, training, and medical evaluation Fit testing Written respiratory protection program Updated as needed, not just annually
OSHA OSHA Standards Exposure Plan Provide Hep B vaccine within 10 days of employment Education should include potential hazards, PPE, engineering controls, work practices Maintain sharps injury log Post Exposure Interventions Disease screening (TB) Occupational environmental controls Testing and retesting is necessary; labs, chest xray HCW medical history
Diseases Disease specific TB Baseline Serial testing without known exposure Known exposure (close contact) Measles, mumps, rubella Live virus, not given to pregnant women or unprotected sex or someone who may become pregnant in the next 30 days. (Pregnancy test.) Within 30 days of another live virus vaccine
Diseases Disease specific Rubella One dose of vaccine or positive titers At least one dose of MMR for those born before 1956 or those who do not have positive titers (exclude personnel from duty with active disease until 5 days after rash appears, post-exposure of susceptible personnel from day 7 after first exposure to 21 days after last exposure)
Diseases Disease specific continued: Measles Documented immunity Vaccinate non-immune Those born on or after 1957 if they have documentation of two doses of vaccine or positive titers Those born before 1957 need documentation or one dose of vaccine of positive titers Vaccinate unknowns who have contact with a measles patient w/in 72 hrs, exclude from duty 5 days after first exposure to 21 days
Diseases Disease specific continued: Mumps Physician documentation of mumps or positive titers Unknown receive two doses of MMR
Disease specific continued: Meningococcal meningitis Post exposure prophylaxis advised for those with direct intimate contact with infected person (mouth-to-mouth, intubation, endo trach suctioning.) Also should be offered to lab personnel processing soluble solutions of the disease. Prophy immediately after exposure with: Ciprofloxacin oral (non-pregnant adults only) Cefotaxime IM (children or pregnant females) Rifampin oral (for both children and adults)
Disease specific continued: Hep B Assessment of potential for exposure Vaccine status Revaccinate non-responders followed by retesting Prophylaxis treatment; begin series at time of exposure and administer HBIG within 24 hours Booster doses aren t necessary
Disease specific continued: Hep C Average risk of transmission with needlestick is 1.8% No prophylaxis recommended Advise exposed HCW should not donate blood, plasma, tissue or semen Exposed HCW to positive source baseline testing: ALT, AST at 4 to 6 months post exposure and HCV RNA post 4 to 6 weeks Specialist referral
Disease specific continued: HIV Average risk of transmission with needlestick is 0.3%, 0.1% for mucus membrane contact, and <0.1% for nonintact skin contact Immediate post exposure, HCW and source tested, f/u in 6 weeks, 3 months, and 6 months Post exposure counseling with PEP regime Consider re-evaluation of exposed person within 72 hours If source HIV-negative stop PEP PEP not contraindicated in pregnancy (consult obstetrician)
Disease specific continued: Varicella Varicella history highly immune Positive titers or documentation of vaccine Vaccinate those without immunity Test immediately post exposure Post exposure: Furlough those with negative or inadequate titer from day 10 thru day 21 post exposure, or monitor for development of symptoms If fever, URI, or rash, exclude from duty and administer vaccine Varicella-zoster immune globulin may be given under 16 yrs or immunocompomised over 15 yrs
Disease specific continued: Scabies Contact precautions, evaluate for signs and symptoms, spread by skin to skin contact with an infested person, provide appropriate therapy for confirmed or suspected cases Pediculosis Infestation with human lice (head, body, pubic or crab) Provide treatment No prophylaxis
Disease specific continued: Pertussis Highly contagious, HCW immunity Direct patient care workers should receive one dose of Tdap Prophylactic treatment using Erythromycin 500 mg 4 x daily or one tab of trimethoprim-sulfamethoxazole (Septra) BID Influenza Recommended for all HCW Annual flu prevention campaign PRN (e.g. outbreaks) prophylaxis for patients, residents, & workers
Performance Improvement for E/OH Purpose Effectiveness of prevention programs Choose most effective means of prevention Prove cost-effectiveness of injury and exposure prevention Measures Monitor injuries/exposures over time Root cause analysis Develop and implement prevention strategies Educate Track and trend Monitor actions involving injury/illness Monitor devices used during injury
Performance Improvement continued: Calculate PIP Rates of reported injury/exposure calculated by: Total number of injuries (in one year) divided by total number of occupied beds, further divided by average daily census (per calendar year) Total number of percutaneous injuries by nurses (in one year) divided by total number of full-time equivalent nurses employed that year Number of percutaneous injuries from device type (in one year) divided by number of that device type used or purchases in the same year Cost-effectiveness of injury and exposure prevention
Questions: Which of the following statements is true regarding storage of vaccines? a. Vaccines should be taken out of the original packaging b. Vaccines should be stored in a labeled container/bin on the middle shelf a few inches from the wall c. Vaccines should be packed tightly into the fridge d. Vaccines should be stored in the top of the refrigerator
Answer B- vaccines should be stored in a labeled container/bin on the middle shelf a few inches from the wall Rationale- Vaccine storage and handling errors can reduce vaccine potency and result in inadequate immune responses and protection against disease. The CDC recommends the following regarding vaccine storage: Place in the central area of the unit away from walls vents and coils Avoid placing vaccines on top shelf There must be enough room to store the year s largest inventory without crowding A calibrated thermometer should be placed inside each storage unit The storage unit must be dedicated to the storage of vaccines
Questions: An employee is exposed to a patient known to have chronic Hepatitis B. The employee is a known responder to the Hep B vaccine, which was given to him as a student 5 years ago. What is the recommended post-exposure treatment for the employee? a. Test the employee and all close personal contacts for Hep B b. Start the Hep B series on the employee because of the length of time since vaccination c. No treatment is recommended for a known responder d. Recommend giving the employee the Hep A Vaccine
Answer C- no treatment is recommended for a known responder Rationale: According to the CDC Guidelines, when the employee is known to have converted to positive Hep B antibody following immunization series, no treatment is recommended
References: Certification Study Guide 6 th Edition