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)

EMPLOYEE/OCCUPATIONAL
HEALTH PROGRAMS

PROGRAM OBJECTIVES
(RELATED TO INFECTION
PREVENTION)

Educate personnel
Principles

Collaborate with IP
Monitor

of IP and personnels role in prevention

and investigate exposures and outbreaks

Provide care to personnel

Work-related

Identify risk and institute preventive measures

Work-related

illness or exposure
infection risks

Contain costs by preventing infectious diseases

Absenteeism

and disability

OPERATIONS
Screening
Education and counseling
Occupational illness and injury treatment
Nonoccupational illness treatment
Preventive health services
Environmental assessment and control
Record keeping

COMMUNICATION WITH IP
Personnel exposure
Personnel infections
Community and personnel outbreaks
Policies and procedures
Educational programs for personnel

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

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

EDUCATION
New employee orientation & annual updates
Postexposure counseling (Bloodborne Pathogens)
TB screening and positive conversions
Workers comp issues
Pregnant worker concerns
Community-acquired infections
Influenza prevention
MMR & Varicella protection and prevention
Screening test results
Guidelines for illness

ACTION PLAN: DETECTION

History of disease
Symptoms
Labs
Reporting cases to health department

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

SCREENING PROGRAMS

DECIDING TO SCREEN
Disease in local population
Risk of significant exposure
Cost of screening
Implication of the screening results

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

WHAT TO DO AT A SCREENING
Medical history
Health assessment
Lab work
TB screening
Immunizations

This information is confidential!

COMMUNICABLE DISEASES TO
SCREEN FOR
Tuberculosis (TB)
Rubella
OB & Pediatrics rubella, varicella, pertussis
Blood/Body fluid exposures hepatitis B

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

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

BLOODBORNE PATHOGENS
exposure plan and immunization

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

EXPOSURE PROCEDURES
1.
2.
3.
4.
5.
6.

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

POSTEXPOSURE COUNSELING
Risk of infection
Signs and symptoms of infection
Prophylaxis
Testing
Side effects of medications
Interim precautions
Risk reduction measures

RESPIRATORY
PROTECTION PROGRAM

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

FIT TEST

Qualitative
Pass/Fail

Adequacy

of fit

Quantitative
Adequacy

of fit
Measures amount of leakage

Not required for PAPR (Powered air-purifying

respirator)

WORK RESTRICTIONS
active infections and post-exposure

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 personnelor

this will undermine reporting

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

CDC RECOMMENDATIONS

Disease and symptom-specific guidance

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

POST-EXPOSURE

DISEASES WITH NO POSTEXPOSURE TREATMENT

Herpes simplex
Cytomegalovirus
Meningitis other than N. meningitidis
RSV
Rotavirus
Hepatitis C (Controversial)

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

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

Pertussis
HIV

and treat if infested, no prophylaxis

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

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

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)

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

POST-EXPOSURE: HIV
Immediately test personnel and source for HIVAB status
Baseline testing and follow up for 6 months

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

IMMUNIZATIONS

VACCINE PREVENTABLE DISEASES

Hepatitis A and B
Influenza
Measles
Mumps
Rubella
Tetanus and diphtheria
Pertussis
Polio
Varicella-zoster (Chickenpox)

CDC RECOMMENDATIONS

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

PERFORMANCE
IMPROVEMENT MEASURES