CIC Employee Health Flashcards
HCW illness work restrictions - what to consider
- agent
- agent transmission mode and interruption
- should not be punitive to avoid hesitancy to report
- policy and procedures should define those with authority to impose restrictions
- population risk and susceptibilty
Postexposure counseling
- infection risk
- s/s infection
- prophylaxis
- testing
- medication side effects
- interim precautions
- risk reduction measures
TB Postexposure
- skin test upon hire, based on facility risk assessment
- skin test upon exposure & 10 weeks after
- if positive, CXR, liver panel
- MD evaluation
- Test immunocompromised every 6 months due to possible inability to react sufficiently to skin test
HCW BBP postexposure- order of what to do
- 1st aid, clean site
- Notify supervisor
- HCW and source baseline HIV, HBV, HCV
- Reports
- Postexposure counseling
HCW Respiratory Protection
- N95s: annual fit test required; fit test required prior to need for use
- PAPRs: no fit test required
- qualitative fit test: adequacy of fit, pass or fail
- quantitative fit test: assess amount of leaking into respirator
HCW - Measles, mumps, rubella
- Live vaccine, do not give to pregnant women
- Considered immune after 2 doses of MMR or serological evidence
- Rubella furlough: day 7 after first exposure through day 21 after last exposure
HCW - Measles postexposure
- Measles vaccine with 72 hrs of exposure
- Furlough 5 days after first exposure and 21 days after last exposure
Hepatitis B postexposure
- Assess HCW HBV upon hire
- Revaccinate non-responders with 3 dose series
- HBV exposure if source patient HbsAg + or status unknown
- If exposed HCW is vaccinated, but response unknown, baseline anti-HBs
- Unvaccinated exposure HBIG within 24 hrs
HIV postexposure
- Baseline HIV-AB for exposed person and source
- Repeat HIV-AB for exposed at 6 weeks, 3 and 6 months
- Post exposure prophylaxis started ASAP, stop if source HIV-AB negative (not contraindicated in pregnancy)
N. meningitis postexposure
- Postexposure prophylaxis for persons with direct, intimate contact
- Pre-exposure vaccination for lab personnel
- Furlough until 24 hrs effective antibiotic therapy
Hepatitis C Postexposure
- No proplylaxis indicated
- Baseline anti-HCV and ALT, repeated in 4-6 months
Varicella postexposure
-Serological screening of negative or unknown hx
-Furlough those with inadequate titers from day 10-21 postexposure, or monitor daily for s/s
-If symptomatic, varicella vaccine
VZIG if 15 yrs and immunocompromised
-Furlough until lesions dry & crusted
Scabies & lice postexposure
- prolonged skin to skin contact
- treatment given to HCW with infestation evidence
- No prophylaxis
Influenza postexposure
- annual HCW influenza vaccination
- chemoprophylaxis to exposed patients, residents, HCW during outbreak
Pertussis postexposure
- highly contagious
- TDaP upon hire
- Prophylaxis: erythromycin or trimethoprim-sulfamethoxazole
- Furloughed until 5 days antibiotics, or beginning of catarrhal stage through 3rd week after onset of paroxysms
Conjunctivitis work restriction
-no contact with patient or patient environment until drainage ceases
Diarrhea work restriction
- no patient contact or food handling during acute phase
- If Salmonella, restrict from high risk patients until s/s resolve
Diptheria work restriction
-restricted until antibiotic therapy completed and 2 negative cultures (24 hrs apart)
Hepatitis A work restriction
-restricted from patient contact of food handling until 7 days after onset of jaundice
Herpes simplex work restriction
- genital: no restriction
- hands (herpes whitlow) - no patient contact until lesions healed
- orofacial - restrict from high risk populations
Enteroviral work restriction
-restricted from caring for infants and immunocompromised patients until symptoms resolve
Hep B&C, HIV work restriction
-no recommendations, expert review council
MDRO work restriction
-no recommendations
Respiratory virus work restriction, e.g. RSV
-symptomatic HCW no patient contact
Strep A work restriction
-restrict from patient contact or handling food until 24 hrs antibiotic therapy
Varicella zoster (shingles) work restriction
- cover lesions, restrict from high risk patients
- if immunocompromised, restrict until lesions dry and crusted
- zoster vaccine 1 dose for persons > 60 yrs
Staph infection restrictions
-if drainage, restrict from patient contact
TB work restriction
- active: restrict until proven noninfectious
- PPD converter: no restriction
HCW TB positive skin test results
- baseline: >/_ 10mm
- serial testing without known exposure: increased from last read
- known exposure: >/5 if baseline 0; >/ 10 if baseline not zero, but less than 5, or followup zero
