CIC Employee Health

Question 1

HCW illness work restrictions - what to consider

Answer 1

• 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

Question 2

Postexposure counseling

Answer 2

• infection risk
• s/s infection
• prophylaxis
• testing
• medication side effects
• interim precautions
• risk reduction measures

Question 3

TB Postexposure

Answer 3

• 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

Question 4

HCW BBP postexposure- order of what to do

Answer 4

• 1st aid, clean site
• Notify supervisor
• HCW and source baseline HIV, HBV, HCV
• Reports
• Postexposure counseling

Question 5

HCW Respiratory Protection

Answer 5

• 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

Question 6

HCW - Measles, mumps, rubella

Answer 6

• 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

Question 7

HCW - Measles postexposure

Answer 7

• Measles vaccine with 72 hrs of exposure

- Furlough 5 days after first exposure and 21 days after last exposure

Question 8

Hepatitis B postexposure

Answer 8

• 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

Question 9

HIV postexposure

Answer 9

• 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)

Question 10

N. meningitis postexposure

Answer 10

• Postexposure prophylaxis for persons with direct, intimate contact
• Pre-exposure vaccination for lab personnel
• Furlough until 24 hrs effective antibiotic therapy

Question 11

Hepatitis C Postexposure

Answer 11

• No proplylaxis indicated

- Baseline anti-HCV and ALT, repeated in 4-6 months

Question 12

Varicella postexposure

Answer 12

-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

Question 13

Scabies & lice postexposure

Answer 13

• prolonged skin to skin contact
• treatment given to HCW with infestation evidence
• No prophylaxis

Question 14

Influenza postexposure

Answer 14

• annual HCW influenza vaccination

- chemoprophylaxis to exposed patients, residents, HCW during outbreak

Question 15

Pertussis postexposure

Answer 15

• 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

Question 16

Conjunctivitis work restriction

Answer 16

-no contact with patient or patient environment until drainage ceases

Question 17

Diarrhea work restriction

Answer 17

• no patient contact or food handling during acute phase

- If Salmonella, restrict from high risk patients until s/s resolve

Question 18

Diptheria work restriction

Answer 18

-restricted until antibiotic therapy completed and 2 negative cultures (24 hrs apart)

Question 19

Hepatitis A work restriction

Answer 19

-restricted from patient contact of food handling until 7 days after onset of jaundice

Question 20

Herpes simplex work restriction

Answer 20

• genital: no restriction
• hands (herpes whitlow) - no patient contact until lesions healed
• orofacial - restrict from high risk populations

Question 21

Enteroviral work restriction

Answer 21

-restricted from caring for infants and immunocompromised patients until symptoms resolve

Question 22

Hep B&C, HIV work restriction

Answer 22

-no recommendations, expert review council

Question 23

MDRO work restriction

Answer 23

-no recommendations

Question 24

Respiratory virus work restriction, e.g. RSV

Answer 24

-symptomatic HCW no patient contact

Question 25

Strep A work restriction

Answer 25

-restrict from patient contact or handling food until 24 hrs antibiotic therapy

Question 26

Varicella zoster (shingles) work restriction

Answer 26

• cover lesions, restrict from high risk patients
• if immunocompromised, restrict until lesions dry and crusted
• zoster vaccine 1 dose for persons > 60 yrs

Question 27

Staph infection restrictions

Answer 27

-if drainage, restrict from patient contact

Question 28

TB work restriction

Answer 28

• active: restrict until proven noninfectious

- PPD converter: no restriction

Question 29

HCW TB positive skin test results

Answer 29

• 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