Employee/Occupational Health Flashcards
If there is unprotected exposure to TB, when should the TST be administered?
at the time of exposure and 12 weeks post-exposure
Who are chest radiographs performed on?
Those with prior positive TST and who are currently symptomatic
What are the elements of an occupational health program?
- Surveillance
- Education
- Immunization
- Injury prevention and response
Infectious processes can be prevented with what 3 basic principles?
- pre-exposure immunization
- post-expore interventions
- prevention strategies
What are some infection prevention objectives of an occupational health program?
-educate HCP on IPAC principles as it pertains to their responsibilities
-collaborate with the IPAC department in monitoring exposures and outbreaks
-provide personnel for work related illnesses or exposures
-identify work related infection risks and institute preventative measures
-contain costs by preventing infectious diseases that result in absenteeism and disability
who should be vaccinated against polio and what is the schedule?
-lab and other HCP who come in contact with the live virus
-3 doses of 0.5ml subscutaenously.
-First two doses separated by 4 to 8 weeks, and a third dose 6-12 months after the second
Who should receive the Td vaccine and what is the schedule?
-persons without a history or unknown Td history or if it has been more than 10 years since the last dose
-unimmunized: 3 doses of 0.5ml IM at 0,1 to 2,6 months
Booster: 1 dose every 10 years
Who should receive the Tdap vaccine and on what schedule?
-HCP with direct patient contact, health adults 19-64, close contacts (<1 year Td dose)
-0.5ml IM one time dose
Who should receive the varicella vaccine and on what schedule?
-adults nonimmune to varicella
-0.5ml subcutaenously at 0 weeks and 4-8 weeks later
who should receive the Hep A vaccine and on what schedule?
-lab and primate workers
-1ml IM at 0,6 months
Who should receive the hep B vaccine and on what schedule?
-occupational exposure to blood/bodily secretions
-3 doses IM at 0, 1 and 6 to 12 months
Who should receive the MMR vaccine and what is the schedule?
-adults born after 1957 without a history of diagnsoed measles, immunity, or vaccine documentation
-0.5ml SQ at 0, and at least 1 months later
who should receive the rubella vaccine?
unimmunized women of childbearing age and HCP
-anyone born before 1957 without lab evidence of ommunity
MMR individual vaccine are given at what dosage?
0.5ml SQ once
True or false. No work restriction is necessary for HCP with cytomegalovirus infection?
True
What is the work restriction for diptheria and duration?
-exclude from duty until antimicrobial therapy has been completed and two cultures have been obtained 24 hours apart that are negative
What are the work restrictions and duration for enteroviral infections?
restrict from care of infants, neonates, and immunocomprimised patients and their environments until symptoms resolve
What are work restrictions and duration for hepatitis A?
-restrict from patient contact, contact with patients environment, and food handling
-until 7 days after jaundice onset
What are the work restrictions for someone with Hep B?
-no restrictions if they do not perform exposure-prone procedures , SP, refer to state regulation
-if you have acute or chronic hep B e antigenemia, do not perform exposure-prone invasive procedures until counsel from an expert panel has been sought (review procedures they can perform, state regulations)
-duration: until hep B e antigen is negative
What are the work restrictions and duration for hep C?
-no recommendation for restrictions
-restrict until lesions heal
What are work restrictions for herpes simplex?
None
What are work restriction for herpetic whitlow?
restrict from contact and contacts with the patients environment
what are work restrictions for someone with genital herpes?
None
what are work restrictions for someone with orofacial herpes?
evaluate need to restrict from contact with high-risk patients
what are work restricts for someone with acute stage (symptoms) diarrheal disease?
restrict from patient contact, contact with patients environment, food handling until symptoms resolve
what are work restrictions for someone with convalescent stage, salmonella (stays in stool post infection)
restrict from care of high risk patients until symptoms resolve, consult with health authorities on need for obtaining negative stool cultures
what are the work restrictions and duration of someone wtih active measles?
exclude from duty until 7 days after the rash appears
what are the work restrictions postexposure (susceptible personnel) for measles?
-from 5th day after first exposure through 21st day after last exposure and/or 4 days after rash appears
what are work restrictions for someome with meningococcal infection?
exclude from duty until 24 hours after the start of effective therapy
what are the work restrictions for someone with active mumps?
exclude until 9 days after the onset of parotitis
what are the work restrictions for someone post exposure susceptible to mumps?
from 9th day after first exposure through 26th day after last or until 9 days after parotitis onset
What are pediculosis work restrictions?
restrict from patient contact until treated and observed to be free of adult and immature lice
what are active pertussis restrictions?
ecxlude from duty from beginning of catarrhal stage through third week after onset of paroxysms or until 5 days after the start of ab therapy. They do not need to be restricted unless symptoms develop.
do asymptomatic workers exposed to pertussis need to be restricted?
No; prophylaxis is recommended
what are post exposure recommendations for personnel exposed to pertussis who are symptomatic?
exclude until 5 days after the start of effective ab therapy
what are rubella work restrictions (active)?
exclude from duty until 5 days after rash appears
what are rubella work restrictions when exposed and susceptible?
exclude from the 7th day after first exposure through 21st day after last
do persons carrying staph aureus need work restrictions?
no, unless they are epidemiologically linked to transmission of the organism
what are work restrictions for staff with active staph draining skin lesions?
restrict from contact with patients and patients environment or food handling until lesions have resolved
what are work restrictions for group A strep?
restrict from patient care, contact with patients environment, or food handling until 24 hours after treatment started
what are work restrictions for staff with active TB?
exclude until proved non infectious
what are work restrictions for staff with TB PPD converter?
no restriction
what are work restrictions for staff with active varicella?
exclude until all lesions are dried and crustedw
what are work restrictions for staff postexposure and susceptible to varicella?
exclude from the 10day after first exposure through the 21st day after last (28th day if VZIG given)
what are work restrictions for zoster in a localized, healthy person?
cover lesions and restrict from care of a high risk patient until lesions and dry and crusted
what are work restrictions for zoster generalized or localized in an immunosupressed persons?
restrict from patient contact until all lesions dry and crustw
what are work restrictions for zoster postexposure (susceptible personnel)?
restrict from patient contact from the 10th day after first exposure through 21st day from last (28th if VZIG given) or, if infection occurs, until lesions crust
define LTBI
a condition after initial infection with TB. within 2-12 weeks, the immune response limits additional multiplcation of tubercle bacilli and test results for TB become positive. Certain bacilli remain in the body and viable for years. These persons are asymptomatic and not infectious.
What testing can be done for TB
-PPD based TST for LTBI
-in-vitro cytokine based immunoassays
what do TB tests measure?
cell-mediated immune responses to peptides from 2M TB proteins that are not present in BCG vaccines and absent from nonTB mycobacterium
Can tine tests be used to diagnose TB?
NO
Should BCG vaccinated individuals be included in a TB screening program?
Yes unless they have documentation of a previous positive reaction
When should a 2 step TST be performed?
when the initial is negative and there is no documented TST in the last 12 months
Interpretation of the TST depends on what? (hint there are 3 things)
- measured induration in mm
- persons risk of being infected
- risk of progression to active disease if infected
What do you do if a TST is positive?
a chest radiograph
-obtain exposure history (determine if occupational or community-associated)
-report symptoms of active TB
do chest radiographs need to be repeated?
no, unless the person is symptomatic
A baseline TST is considered positive when
> 10mm first or second step
if you are serial testing without known exposure, what would be a positive TST result?
increase of >10mm
if you had a known exposure, what is considered a positive TST?
> 5mm if you had a baseline of 0mm
define workers compensation
a system of insurance that reimburses an employer for damages that must be paid to an employee with injury or exposure during the course of employment
what is a risk assessment and what should it focus on?
tool to determine gaps in the organization. focus on client, patient population, type of facility, services provided, geographical location, endemic diseases
define cutaneous anergy
inability to react to a skin test due to delayed T cell hypersensitivty
is treatment of latent TBI recommended?
yes, unless medically contraindicated
How long are personnel with laryngeal or pulmonary TB excluded from work for?
until responding to anti-TB treatment and until 3 consecutive negative sputum smears have been collected 8-24 hours apart
What are some OSHA requirements?
-respiratory protection program for HCP working in an environment that could require a respirator
-exposure control plan (for BBP)
What worksite procedures should be included in the respiratory protection program?
-fit testing procedures
-medical evaluations
-use, storing, and discarding
-training and use (maintainence, donning and doffing)
-selecting respirators
what is the difference between a qualitative and quantiative fit test
a qualitiative fit test relies on taste and smell to determine proper fit whereas a quantiative fit test measures actual leakage into the mask
OSHA requires HBV vaccination be offered for free within ___ days of employment
10
true or false. OSHA requires a sharps injury log be maintained
true
describe the OSHA BBP standard
provide training on potential haxards, PPE, engineering controls, and work practices BEFORE the employees initial assignment
is post vaccine screening recommended after HBV vaccination?
yes; 1-2 months after
what do you do if someone does not respond to the HBV vaccine?
re-vaccinate with an additional 3 dose series
CDC recommends one time testing for this virus for HCP exposed to infected blood
HEP C
true or false. personnel with HEP C should be restricted from work?
False
What is the risk of HIV transmission?
0.3% for percutaenous; 0.01% for mucous membrane contact; less than 0.01% for non-intact skin contact
what are risk factors for HIV transmission?
deep injury from a device with visible blood that came from the patients vein or artery; the source patient dying within 90 days of AIDs
True or false. You should test to establish HIV-AB immediately after exposure?
True
When does varicella transmission occur?
1-2 days before symptom onset and until all lesions are crusted
What are work restrictions for personnel who are vaccinated and exposed to varicella?
serotest. Exclude 10th to 21st day if seronegative
VZIG is not recommended for who? Who is it recommended for?
-not recommended for immunocompetent personnel
-recommended for pregnant or immunocomprimised as PEP
PEP for meningococcal is recommended when?
prolonged intensive contact with infected patients (no mask, mouth to mouth, endotracheal intubation, endotrachel tube management, or close examination of the oropharynx)
when should PEP be administered for meninogococcal?
immediately after exposure
True or false. lab personnel should get a pre-exposure meningococcal vaccine and booster every 5 years
True
what antimicrobials are given for meningococcal?
rifampin 600mg orally every 12 hours for 2 days; a single cipro dose 500mg orally; single dose of ceftriazone 250mg IM
-rifampin and cipro are not recommended for pregnant women
What are work restrictions for rubellaif you are exposed and not immune?
exclude from 7th to 21st day after exposure if not immune
mumps is caused by which organism/virus?
paramyxovirus
what is the mumps incubation period?
16-18 days
what is the MMR vaccine schedule?
2 doses 28 days apart
What constitutes measles immunity?
-2 doses; lab evidence; confirmation of disease; born before 1957
True or false. You have presumptive immunity to mumps if before 1957 or earlier
True
How soon after exposure should the measles vaccine be given?
72 hours
Should scabicides or pediculcides prophylacticely be routinely offered?
no; only when there is transmission
Does the CDC recommend prophylaxis for pertussis?
Yes; erythromycin, azithromycin, clarithromycin (trimethoprim and sulfamethoxodale an option)
When is Influenza infectious?
From symptom onset to 7 days after
who are high risk patients for herpes?
neonates, burn victims, immunocomprised, intensive care unit patients
Which is less contagious zoster or varicella?
zoster
When is localized zoster contagious?
when rash erupts until lesions crust
You are immune to VZV when antibodies are
reactive
Which virus can cause birth defects when women are infected during pregnancy?
CMW
Who is the resesrvoir for CMV?
infants and immunocomprimised
how is CMV spread?
direct contact with infectious body fluids
Which virus causes 5th disease?
parvovirus
how is parvovirus spread?
before the rash appears. Through contact with infected persons, fomites, large droplets
are pregnant personnel at a greater infection risk for parvovirus?
no; but it can cause fetal death in the first half of pregnancy
What are work restrictions for staff with MDROs?
if draining lesions, restrict from patient care and food handling
what is the largest cause of HCP exposure to blood and infectious materials?
percutaenous injuries from sharps
Define work practice controls
Practices that reduce the possibility of exposure by changing the way a task is performed
Define non-employee
volunteers and contract workers not directly employed by the facility but authorized to provide services.
Are pregnant women considered immunocomprimised?
no, there immunologic function is normal
True or false. There is a decrease in cell-mediated immunity in the third trimester to viruses and pathogenic fungi
True
Does varicella zoster in unimmunized women present a risk to the mother and neonate?
yes
Pregnant women may ber estricted from caring for patients with which infections?
Parvovirus B19 and RSV receiving ribavirin aerosol
Which vaccines are not recommended during pregnant?
live vaccines like rubella, rubeola, varicella, and smallpox
healthcare acquisition of which diseases is unlikely for pregnant HCP?
toxoplasmosis and HSV
Post exposure chemoprophylaxis is effective for pregnant HCP for which agents?
HIV, syphillis, meningitidis
IPAC is the only preventative measures for which infectious agents?
-parvovirus B19
-CMV
-TB
-HCV
which precautions are used for parvovirus?
droplet
Which vaccines should a pregnant HCP have?
-MMR
-Varicella
-tetanus
-diptheria
-polio
-or evidence of having had the disease before pregnancy
Which vaccines are contraindicated for pregnant women?
-HPV
-Influenza LAIV
-MMR
-Varicella
-zoster (shingles)
Which vaccines have insufficient data for pregnant HCP recommendation?
pneumonococcal
How is CMV transmitted?
sexual contact or direct contact with infected urine, saliva, semen, vaginal secretions, or breast milk.
What are primary risks for infections about seronegative women for CMV?
-under 25
-multiple sexual partners
-exposure to young children (especially those at day care)
Do HCP have an increased risk of acquisition of CMV infection?
No
How does CMV usually spread?
asymptomatic primary and recurrent infections, multiple sites of excretion, prolonged and intermittent excretion, and excretion of virus despite presence of immunity
HAV replicates in the ____, is excreted in the ____ and shed in the _____
liver; bile; stool
When is HAV peak infectivity?
during the 2 weeks before jaundice onset or elevation of hepatic transaminases, when viral concentration in stool is the greatest
How is HAV usually transmitted?
stool but blood can be a source for a short period of time
Has maternal HAV transmission of the fetus been estbalished?
No
What are some HAV infection risks during pregnancy?
-systemic infections
-spontaenous abortion
-preterm delivery
What should be done if someone is not vaccinated and exposed to hep B?
begin the vaccine series at the time of exposure and administer hep B immune globulin ASAP, preferably within 24 hours
What do you do if a person is vaccinated and exposed to hep B, but vaccine response is unknown?
perform a baseline test for anti-HBs
When is baseline testing not necessary after hep B exposure?
if the person has not been vaccinated or vaccine response is known
The average risk of HCV transmission after percutaenous exposure is ____ and ____ for mucocutaenous exposure
0.2%; 0%
What is the HCV incubation period
2-24 weeks (average 6-7 weeks)
is HBV infection during pregnancy dangerous?
Yes, it can result in severe disease for the mother, fetal loss, or chronic infection of the neonate if born alive
is pregnancy a contraindication for hep B vaccination?
No
What is the vaccination schedule for newborns born of HBsAg positive mothers?
administer HBIG 0.5ml IM and single antigen hep B vaccine at separate injection sites within 12 hours of birth
Is there a vaccine or effective therapy for hep C during pregnancy?
No and there is nothing for the post natal period
hep C infection during the first and second trimesters can cause
fetal hepatic injury
how is hep C transmitted?
sexually, by exposure to blood via transfusion, sharing needles for intravenous drug use, percutaneous injury, rarely perinatal exposure
Healthcare associated herpes is usually caused by
herpetic whitlow from now wearing gloves when contacting mucous membranes.
humans are the sole natural host for what virus?
herpes
are HPV vaccines recommended for pregnant women?
No
what should a woman do if she gets pregnant after beginning the HPV vaccination series?
delay the rest of the 3-dose series until completion of pregnancy
risk of percutaenous HIV transmission is increased with ________ and when _____________
hollow bore needles and when an increased volume of blood is injected.
can pregnant HCP get PEP for HIV?
yes; treat them as any other person with an exposure
True or false. Pregnant women are at an increased risk of severe illness from Influenza
True
Influenza vaccine is recommended for all persons age what?
> 6 months
get pregnant women get the MMR vaccine?
NO
women should be advised to avoid becoming pregnant for _____ after getting an MMR vaccine
28 days
what is the causative agent of erythema infectiosum?
parvovirus B19
What is the risk of parvovirus to the fetal of a pregnant HCP?
can cause infection of fetal red blood cell precursors and lead to severe anemia and high output cardiac failure of the fetus, hydrops fetalis, and fetal death.
How is parvovirus transmitted and what are the precautions?
-respiratory secretions during close contact
-droplet precautions
what is the pertussis incubation period?
7-10 days
What are the 3 phases of pertussis?
- catarrhal
- paroxysmal
- convalescent
how is pertussis transmitted?
large respiratory droplets generated by coughing or sneezing
most pertussis deaths occur in what age group?
less than 2 months old
who is most likely to develop severe pertussis?
anyone younger than 12 months especially younger than 3 months
can pregnant women get the varicella vaccine?
no
when is varicella contagious?
1 day before rash onset until all lesions have crusted
What is the most common complication of chickenpox?
chickenpox pneumonia. occurs in 15-50% of adults who do not get treated with antivirals (acyclovir)
is acyclovir recommended for pregnant women with chickenpox?
Yes
when is VZIG recommended for pregnant women?
when there is no evidence of immunity
when should VZIG be administered as PEP?
ASAP, ideally within 96 hours
What vaccines should HCP have?
-influenza (sep-May)
-Tdap (one time)
-Td (every 10 years)
-shingles
-varicella
-MMR
-Hep H
how is the hep b vaccination series given?
3 series IM injections:
-2nd at least 4 weeks after first
-3rd 5 months after second
After an exposure, when must hep b vaccination be offered?
within 10 days
does a sharps safety risk assessment apply to residents who perform unassisted glucose monitoring?
No
How long do employee files need to be kept?
For 30 years unless employment was <1 year
Anti-HBc
present during and after infection
anti-HBc IgG
chronic infections
Anti-HBc IgM
recent infection
what are the TB plan components?
-screen new hires and admissions
-train/educate employees on hire and annually
-fit test employees to respirators
-if accepting patients with suspected or confirmed infectious TB: have appropriate environmental controls
-if not accepting: have a written protocol for early identification and referral to an organization that can manage.
What are work restrictions for group a strep?
None unless personnel are epidemiology linked to transmission of the organism
