Employee Health Flashcards
Name diseases with post exposure intervention.
TB Rubella Neiserria meningitidis Hep A & B Varicella zoster Pertussis HIV
Name 10 vaccine preventable diseases.
Hep A Hep B Influenza Measles Mumps Rubella Tetanus and diphtheria Pertussis Polio Varicella zoster
Name diseases with no post exposure intervention
Herpes simplex Cytomegalovirus Meningitis RSV Rotavirus Hep C
Factors to consider for work restriction
Agent Mode of transmission Method of interruption of transmission Population at risk Educability and compliance of healthcare worker Clinical status (s & s) Degree & type of patients staff contact
What is QLFT ? Qualitative
Fit test that results in pass or fail, assess adequacy of respiratory fit.
Relies on individuals response to the test agent
What is QNFT? Quantitative
Assessment of the adequacy of the respirator fit by measuring the amount of leakage into the respirator
What is considered an TB Exposure?
HCW with face to face contact
Entering pt room (even if pt not present)
Specimen processing
Installing or maintaining environment where TB patient is located
TB exposure - when is the HCW tested?
Work restriction of HWC a with TB
Baseline & 10 weeks after exposure
Restrict from duty until proven non infectious.
PPD a converter - no work restriction
Interpretation of tuberculin skin test (tst)
> 10 mm is + test
Increase of > 10 mm without known exposure
5 mm with known exposure
When is latent TB detected?
Occurs after initial infection with M tuberculosis within 2-12 weeks
Tested by PPD purified protein derivative
What group should MMR vaccine not be given to?
Pregnant women or those who will become pregnant in 30 days
What are the Requirements for rubella immunity?
Documented immunization with live rubella vaccination
Or laboratory evidence of immunity
One dose of MMR a is recommended for those born before 1956 & no immunity
What are HWC requirements for measles immunity?
Born on or after 1957 if documented measles history, or 2 vaccinations, or serological evidence
Born before 1957- history of measles, 1 vaccination, serological evidence
How to manage measles exposure with no immunity
Give vaccination within 72 hours
Remove from work for 5 days after first exposure to 21 days after last exposure
Who had immunity to Mumps?
MD diagnoses of mumps
2 doses of live vaccine
Serological immunity
Give employees 2 doses of MMR with no immunity
Define N. Meningitidis exposure
HCW with direct intimate contact
Mouth to mouth
Assisting with intubation
Auctioning
What is the recommended prophylaxis for N. Meningitis exposure?
Cipro (adults/non pregnant women)
Cefotaxime IM - children / pregnant women
Rifampin - PO (children or adults)
Give lab workers the injection
What to do with Hep B non responders?
Give additional 3 doses and retest.
If still non responder test HCW for HBSAg.
Non responders in dialysis should be tested q 6 months
Boosters of HBV vaccine are not necessary
If unvaccinated & exposed - give HBIG within 24 hours
Can HIV PEP be given to pregnant HCW
YES
What is exposure requirements for varicella?
Day 10 - 21 monitor daily for S/S. If fever, upper respiratory symptoms, or rash exclude from duty & give vaccine.
Varicella zoster immune glob in can be given to < 15 years or > 15 years if immunocompromised or pregnant
Define scabies exposure
Work restriction
Prolonged skin to skin contact.
Contact precautions
S/S of employees
Restrict from work if pt contact until cleared by medical MD
Define Steps for pertussis exposure
Highly contagious
Employees should receive one dose of Tdap.
Prophylactic 500 mg erythromycin QID
Or one tablet trimthoprim-sufplfamethoxazole BID
Worker restriction for conjunctivitis.
Restrict from pt contact until discharge ceases.
Work restriction for Cytomeglovirus
None
Work restriction for diarrhea
Restrict from pt care or food handling until symptoms resolve.
Work restrictions for diphtheria
Remove from work until anti microbial completed and 2 negative cultures 24 hours apart
Work restriction for enterovirus
Remove from work with infants, neonates, or immunocompromised patients until no symptoms
Work restrictions for Hep A
Restrict from pt contact and food handling for 7 days after onset of jaundice.
Hep A vaccination
Laboratory and primate worker
1 mL IM at 0 and 6 month
Work restrictions for Hep B or HIV
When infectious restrict from invasive procedures.
hep B - no exposure prone procedures unit Hep B e antigen is negative
Hep C work restrictions?
None. Refer to state federal regulations
Work restriction for herpes
Genital- none
Whitlow- pt contact until lesions heal
Facial- restrict from care of high risk patients
Work restriction for measles
Active- exclude for 7 days after rash appears
Post exposure - day 5 to day 21 remove from work. 7 days after rash
Work restriction for meningococcal infection
24 hours after start of effective therapy
Work restriction for parvovirus
Restrict pregnant worker for caring with patients with aplastic crisis, chronic anemia in immunosuppressive
Work restrictions for pertussis
Active - 5 days after effective therapy
Post exposure - none if as asymptomatic. If symptomatic 5 days restriction
Work restriction for varicella?
Active- exclude from work until lesions are dry /crusted.
Post exposure - remove from work day 10 - day 21(day 28 if VZIG was given)
Shingles work restriction
Cover lesions, restrict from high risk patients until crusted over.
Routine vaccination for those over 60
What is the work restriction for Mumps
Exclude from work until 9 days of parotitis.
Post exposure - day 9 to 26 after exposure or until 9 days after onset of parotitis.
How to determine exposure rate
Total # of injuries in 1 year / total # of occupied beds / average daily census
Total # injuries by RN in 1 year / total # FTE RN employed in a year
Number of injuries from a device type in 1 year / number of that device type used or purchased in a year.
What is the name of the blood assay test used to detect TB?
QuantiFERON TB Gold
What is the work restriction for an employee with laryngeal or pulmonary TB?
Exclude until receiving adequate drug therapy, cough resolved, & 3 negative sputum smears for AFB.
How to calculate a TB conversion rate among employees
Divide # conversions/# tested x 100
How to interpret baseline PPD reading (TST)
> 10 mm is positive for baseline test
What is the work restriction for pediculosis? Lice
Restrict fro pt contact until treated and free of lice.
Work restriction for rubella
Remove until 5 days after rash appears
Post exposure - day 7 to 21
Work restriction for scabies?
No patient contact until cleared by medical evaluation
Known exposure to TB what is considered a positive test?
> 5 mm when person had 0
> 10 mm
Work restriction for strep A
No pt contact or pt environment, or food handling until 24 hours of effective treatment
Acute infection early
HBSAG +
Hep B false +
Total anti- HBc +
Hep B chronic infection
HBSAG +
Anti - HBc +
Labs for hep B past infection/immunity
Anti- HBc +
Anti- HBs +
HIV infection
Gradual decline in t-lymphocytes (CD4)
