Employee/Occupational Health (11 questions) Flashcards
Vaccine Preventable Diseases
Hepatitis A and B
Influenza
Measles
Mumps
Rubella
Tetanus and diphtheria
Pertussis
Polio
Varicella-zoster (chickenpox)
Post-Exposure Intervention Diseases
Tuberculosis
Rubella
Meningitis (Neisseria meningitidis)
Hepatitis A, B
Varicella-zoster (chickenpox)
Scabies
Pertussis
Human immunodeficiency virus
No Post-Exposure Intervention Diseases
Herpes simplex
Cytomegalovirus
Meningitis other than N. meningitidis
Respiratory Syncytial Virus (RSV)
Rotavirus
Hepatitis C
Conversion Positive result for TB
HCW with exposure to TB with an increase of ≥10 mm TST
Post exposure skin testing TB
Done at time of exposure and 12 weeks post exposure
- CXR only if prior + TST or symptomatic
- Cutaneous anergy= condition that causes inability to react to skin test because of altered immune function
- immunocompromised: consider retesting every 6 months because of inability to react to Mantoux
proof of immunity to measles,
mumps, and rubella
vaccination with one or more
doses of live vaccine, lab evidence of
immunity, or history of these diseases.
Although birth before 1957 is considered acceptable
evidence of MMR immunity, ACIP recommends
that healthcare facilities consider vaccinating unvaccinated personnel born
before 1957 who do not have laboratory evidence of measles, rubella, and
mumps immunity; laboratory confirmation of disease; or vaccination with two
appropriately spaced doses of MMR vaccine for measles and mumps and one
dose of MMR vaccine for rubella
MMR
live virus, dont administer if preg or will become preg in 30 days
measles- give to HCW within 72 hours post exposure, no work 5 days after 1st exposure to 21 days after last
Meningococcal Meningitis
- pre-exposure offered to lab who handle speciments
- PEP: if intensive, unprotected (no mask) contact.
PEP meds:
Adult (not preg): cipro orally
child, preg: cefotaxime IM
child or adult: Rifampin
Measles exposure
vax given to susceptible workers within 72 hours exposure, no work 5 days after 1st exposure to 21 days after last exposure
Measles is caused by the Rubeola virus and is a highly contagious, respiratory infection. The MMR vaccine, or Measles, Mumps, and Rubella vaccine, is required for all healthcare workers who were born in 1957 or after and do not have serological evidence of immunity. Healthcare workers who are exposed to measles virus and do not have documented evidence of immunity should receive the MMR vaccine within 72 hours of the exposure, and should be excluded from work for the duration of the incubation period of the virus, which is 5 to 21 days.
Hep A work restrictions
restrict from pt contact or food handling until 7 days after onset jaundice
Hep B and HIV work restrictions
restrict if have exposure prone job, otherwise refer to state regulations. If no exposure prone job then no restrictions
Varicella exposure
test for antibodies if no hx of chickenpox.
If - or inadequate titer: exclude from work 10-20 days post exposure (28th day VZIG adm) or if conversion to + then until all lesions are dry or crusted over
HBsAG neg and IGM anti-HBC neg
not currently infeted with Hep B
Total anti-HBc + and anti-HBs +
had Hep B in the past
Human normal immunoglobulin preparations are available for
hepatitis A, measles, polio and rubella; there are also specific immunoglobulin preparations for hepatitis B, rabies and varicella-zoster
Employees that experience a needlestick or sharps injury or who are exposed to blood or other body fluids must immediately follow these steps:
- Immediately seek medical treatment (ED)/first aid or Wash needlesticks and cuts with soap and water
- Flush splashes to the nose, mouth, or skin with water
- Irrigate eyes with clean water, saline, or sterile irrigants
- Report the incident to your supervisor
immunizations recommended for all healthcare personnel who have direct patient contact
Tdap
The Tetanus, Diphtheria, Pertussis vaccine (Tdap) protects against these three different infections. For healthcare workers, the Pertussis component of the vaccine is especially critical because this is a communicable disease and the prevalence of Pertussis in the United States and other developed countries has been trending upward. Pertussis can cause serious respiratory illness, especially in babies under one year of age.
Hep C risk of getting after exposure
Hepatitis C infection is the most common chronic bloodborne infection in the United States. It is primarily transmitted through injection drug use and needle-sharing and may be transmitted through sharp object injury in a healthcare setting. There is no vaccine for Hepatitis C so infection prevention relies on preventing sharp object injuries to healthcare workers. While there are various factors that contribute to overall risk of acquiring Hepatitis C after a sharp object injury, including the depth of the puncture and whether the source needle had been in a blood vessel, the overall risk of acquiring Hepatitis C after exposure is approximately 1.8%
A TST reaction of ≥5 mm of induration is considered positive in:
-HIV-infected persons
-Recent contacts of a person with infectious TB disease
-Persons with fibrotic changes on chest radiograph consistent with prior TB
-Patients with organ transplants and other immunosuppressed patients (including patients taking the equivalent of ≥15 mg/day of prednisone for 1 month or more or those taking TNF-α antagonists)
A TST reaction of ≥10 mm of induration is considered positive in the following individuals:
-Recent arrivals to the United States (within last 5 years) from high-prevalence areas
-Injection drug users
-Residents or employees of high-risk congregate settings (e.g., correctional facilities, long-term care facilities, hospitals and other health care facilities, residential facilities for patients with HIV infection/AIDS, and homeless shelters)
-Mycobacteriology laboratory personnel
-Persons with clinical conditions that increase the risk for progression to TB disease
-Children younger than 5 years of age
Infants, children, and adolescents exposed to adults in high risk categories
TST reaction of ≥15 mm of induration is considered positive in the following individuals
Persons with no known risk factors for TB
HCW without exposure to TB needs ?mm TST for a positive conversion result
> 10 mm
A healthcare worker without known
exposure who demonstrates an increase of ≥10 mm is considered a positive
result.
An employee who is not immune to varicella-zoster was exposed
to a patient with active chickenpox. How long must the employee
remain on work restrictions?
should be excluded
from work duty from the 10th day after the first day of exposure through the
21st days after the last exposure
appropriate temperature for vaccines that require refrigeration
35°F to 46°F (2°C to 8°C)
Most routinely recommended vaccines should be stored in a
refrigerator between 35°F and 46°F (2°C and 8°C), with a desired average
temperature of 40°F (5°C). Exposure to temperatures outside this range
may result in reduced vaccine potency and increased risk of vaccine preventable
diseases.
Times BBF exposure during Dialysis is most likely to occur
initiation and termination of dialysis and during reprocessing, cleaning,
or disinfection procedures.
which type of thermometer should be used in a vaccine
storage unit?
Probe in a glycol-filled bottle with an external
monitoring device
The CDC recommends using a temperature probe in a bottle filled
with a thermal buffer, like glycol, that connects to an external monitoring
device. This allows for temperatures to be monitored without having to
open the unit door. In addition, the CDC recommends the use of digital data
loggers. The CDC does not recommend the use of fluid-filled biosafe liquid
thermometers, infrared thermometers, or chart recorder
(OSHA)
mandates that which of the following vaccines be provided
at no cost to healthcare providers and others at risk for blood
and body fluid exposure
Hep B
Avoiding occupational blood exposures through
adherence to Standard Precautions and other safe work practices is
essential. The most effective means to prevent transmission of bloodborne
pathogens in healthcare settings include Hepatitis B vaccination, the use of
appropriate barriers to prevent blood and body fluid contact, and preventing
percutaneous injuries by eliminating unnecessary needle use, implementing
devices with safety features, using safe work practices when handling
needles and other sharp devices, and safely disposing of sharps and bloodcontaminated
materials. OSHA’s Bloodborne Pathogen Standard mandates
provision of Hepatitis B vaccine at no cost to all healthcare personnel and
others at occupational risk for blood exposure.
work restrictions for inhalation anthrax
They may return to work with no restrictions. inhalation anthrax is not transmissible among humans so these
exposed healthcare workers pose no risk to patients or other employees.
Influenza diagnosis work restrictions
Remain off work for 5 days or until symptoms have resolved, whichever is longer
Influenza is primarily spread between individuals via respiratory
secretions (droplet spread). Viral shedding starts 24 to 48 hours after
infection, and typically 24 hours before the onset of symptoms. Shedding
normally persists less than 5 days but can be longer in children and in
immunocompromised persons. Thus, adults are typically infectious from the
day before symptoms begin until approximately 5 days after the onset of
illness. Staff members who develop influenza illness should be furloughed for
5 days after diagnosis or the duration of their illness, whichever is longer
HCW exposure via needlestick to HIV, first wash off effected area and then?
The employee should be treated as soon as possible with
expanded multidrug PEP
A new employee who needs to be tested for TB infection before starting work has a history of BCG vaccination. Which method of
TB testing would be the best choice in this situation?
An IGRA would be the best choice in this case because it will not
be affected by the employee’s prior BCG vaccination. Other advantages of
IGRAs are that they do not require a follow-up visit to read the test and that
the results are available within 24 hours. However, IGRA testing is generally
more expensive than TST.
proof of immunity for
varicella in a healthcare provider:
(1) evidence of two doses of the varicella
vaccine, (2) laboratory evidence of immunity to varicella, or (3) laboratory
confirmation of disease.
