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LTC-CIP > Employee/Occupational Health > Flashcards

Employee/Occupational Health Flashcards

1
Q

If there is unprotected exposure to TB, when should the TST be administered?

A

at the time of exposure and 12 weeks post-exposure

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2
Q

Who are chest radiographs performed on?

A

Those with prior positive TST and who are currently symptomatic

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3
Q

What are the elements of an occupational health program?

A
  1. Surveillance
  2. Education
  3. Immunization
  4. Injury prevention and response
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4
Q

Infectious processes can be prevented with what 3 basic principles?

A
  1. pre-exposure immunization
  2. post-expore interventions
  3. prevention strategies
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5
Q

What are some infection prevention objectives of an occupational health program?

A

-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

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6
Q

who should be vaccinated against polio and what is the schedule?

A

-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

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7
Q

Who should receive the Td vaccine and what is the schedule?

A

-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

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8
Q

Who should receive the Tdap vaccine and on what schedule?

A

-HCP with direct patient contact, health adults 19-64, close contacts (<1 year Td dose)
-0.5ml IM one time dose

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9
Q

Who should receive the varicella vaccine and on what schedule?

A

-adults nonimmune to varicella
-0.5ml subcutaenously at 0 weeks and 4-8 weeks later

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10
Q

who should receive the Hep A vaccine and on what schedule?

A

-lab and primate workers
-1ml IM at 0,6 months

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11
Q

Who should receive the hep B vaccine and on what schedule?

A

-occupational exposure to blood/bodily secretions
-3 doses IM at 0, 1 and 6 to 12 months

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12
Q

Who should receive the MMR vaccine and what is the schedule?

A

-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

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13
Q

who should receive the rubella vaccine?

A

unimmunized women of childbearing age and HCP
-anyone born before 1957 without lab evidence of ommunity

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14
Q

MMR individual vaccine are given at what dosage?

A

0.5ml SQ once

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15
Q

True or false. No work restriction is necessary for HCP with cytomegalovirus infection?

A

True

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16
Q

What is the work restriction for diptheria and duration?

A

-exclude from duty until antimicrobial therapy has been completed and two cultures have been obtained 24 hours apart that are negative

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17
Q

What are the work restrictions and duration for enteroviral infections?

A

restrict from care of infants, neonates, and immunocomprimised patients and their environments until symptoms resolve

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18
Q

What are work restrictions and duration for hepatitis A?

A

-restrict from patient contact, contact with patients environment, and food handling
-until 7 days after jaundice onset

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19
Q

What are the work restrictions for someone with Hep B?

A

-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

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20
Q

What are the work restrictions and duration for hep C?

A

-no recommendation for restrictions
-restrict until lesions heal

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21
Q

What are work restrictions for herpes simplex?

A

None

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22
Q

What are work restriction for herpetic whitlow?

A

restrict from contact and contacts with the patients environment

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23
Q

what are work restrictions for someone with genital herpes?

A

None

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24
Q

what are work restrictions for someone with orofacial herpes?

A

evaluate need to restrict from contact with high-risk patients

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25
Q

what are work restricts for someone with acute stage (symptoms) diarrheal disease?

A

restrict from patient contact, contact with patients environment, food handling until symptoms resolve

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26
Q

what are work restrictions for someone with convalescent stage, salmonella (stays in stool post infection)

A

restrict from care of high risk patients until symptoms resolve, consult with health authorities on need for obtaining negative stool cultures

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27
Q

what are the work restrictions and duration of someone wtih active measles?

A

exclude from duty until 7 days after the rash appears

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28
Q

what are the work restrictions postexposure (susceptible personnel) for measles?

A

-from 5th day after first exposure through 21st day after last exposure and/or 4 days after rash appears

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29
Q

what are work restrictions for someome with meningococcal infection?

A

exclude from duty until 24 hours after the start of effective therapy

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30
Q

what are the work restrictions for someone with active mumps?

A

exclude until 9 days after the onset of parotitis

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31
Q

what are the work restrictions for someone post exposure susceptible to mumps?

A

from 9th day after first exposure through 26th day after last or until 9 days after parotitis onset

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32
Q

What are pediculosis work restrictions?

A

restrict from patient contact until treated and observed to be free of adult and immature lice

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33
Q

what are active pertussis restrictions?

A

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.

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34
Q

do asymptomatic workers exposed to pertussis need to be restricted?

A

No; prophylaxis is recommended

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35
Q

what are post exposure recommendations for personnel exposed to pertussis who are symptomatic?

A

exclude until 5 days after the start of effective ab therapy

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36
Q

what are rubella work restrictions (active)?

A

exclude from duty until 5 days after rash appears

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37
Q

what are rubella work restrictions when exposed and susceptible?

A

exclude from the 7th day after first exposure through 21st day after last

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38
Q

do persons carrying staph aureus need work restrictions?

A

no, unless they are epidemiologically linked to transmission of the organism

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39
Q

what are work restrictions for staff with active staph draining skin lesions?

A

restrict from contact with patients and patients environment or food handling until lesions have resolved

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40
Q

what are work restrictions for group A strep?

A

restrict from patient care, contact with patients environment, or food handling until 24 hours after treatment started

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41
Q

what are work restrictions for staff with active TB?

A

exclude until proved non infectious

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42
Q

what are work restrictions for staff with TB PPD converter?

A

no restriction

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43
Q

what are work restrictions for staff with active varicella?

A

exclude until all lesions are dried and crustedw

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44
Q

what are work restrictions for staff postexposure and susceptible to varicella?

A

exclude from the 10day after first exposure through the 21st day after last (28th day if VZIG given)

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45
Q

what are work restrictions for zoster in a localized, healthy person?

A

cover lesions and restrict from care of a high risk patient until lesions and dry and crusted

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46
Q

what are work restrictions for zoster generalized or localized in an immunosupressed persons?

A

restrict from patient contact until all lesions dry and crustw

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47
Q

what are work restrictions for zoster postexposure (susceptible personnel)?

A

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

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48
Q

define LTBI

A

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.

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49
Q

What testing can be done for TB

A

-PPD based TST for LTBI
-in-vitro cytokine based immunoassays

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50
Q

what do TB tests measure?

A

cell-mediated immune responses to peptides from 2M TB proteins that are not present in BCG vaccines and absent from nonTB mycobacterium

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51
Q

Can tine tests be used to diagnose TB?

A

NO

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52
Q

Should BCG vaccinated individuals be included in a TB screening program?

A

Yes unless they have documentation of a previous positive reaction

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53
Q

When should a 2 step TST be performed?

A

when the initial is negative and there is no documented TST in the last 12 months

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54
Q

Interpretation of the TST depends on what? (hint there are 3 things)

A
  1. measured induration in mm
  2. persons risk of being infected
  3. risk of progression to active disease if infected
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55
Q

What do you do if a TST is positive?

A

a chest radiograph
-obtain exposure history (determine if occupational or community-associated)
-report symptoms of active TB

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56
Q

do chest radiographs need to be repeated?

A

no, unless the person is symptomatic

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57
Q

A baseline TST is considered positive when

A

> 10mm first or second step

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58
Q

if you are serial testing without known exposure, what would be a positive TST result?

A

increase of >10mm

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59
Q

if you had a known exposure, what is considered a positive TST?

A

> 5mm if you had a baseline of 0mm

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60
Q

define workers compensation

A

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

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61
Q

what is a risk assessment and what should it focus on?

A

tool to determine gaps in the organization. focus on client, patient population, type of facility, services provided, geographical location, endemic diseases

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62
Q

define cutaneous anergy

A

inability to react to a skin test due to delayed T cell hypersensitivty

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63
Q

is treatment of latent TBI recommended?

A

yes, unless medically contraindicated

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64
Q

How long are personnel with laryngeal or pulmonary TB excluded from work for?

A

until responding to anti-TB treatment and until 3 consecutive negative sputum smears have been collected 8-24 hours apart

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65
Q

What are some OSHA requirements?

A

-respiratory protection program for HCP working in an environment that could require a respirator
-exposure control plan (for BBP)

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66
Q

What worksite procedures should be included in the respiratory protection program?

A

-fit testing procedures
-medical evaluations
-use, storing, and discarding
-training and use (maintainence, donning and doffing)
-selecting respirators

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67
Q

what is the difference between a qualitative and quantiative fit test

A

a qualitiative fit test relies on taste and smell to determine proper fit whereas a quantiative fit test measures actual leakage into the mask

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68
Q

OSHA requires HBV vaccination be offered for free within ___ days of employment

A

10

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69
Q

true or false. OSHA requires a sharps injury log be maintained

A

true

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70
Q

describe the OSHA BBP standard

A

provide training on potential haxards, PPE, engineering controls, and work practices BEFORE the employees initial assignment

71
Q

is post vaccine screening recommended after HBV vaccination?

A

yes; 1-2 months after

72
Q

what do you do if someone does not respond to the HBV vaccine?

A

re-vaccinate with an additional 3 dose series

73
Q

CDC recommends one time testing for this virus for HCP exposed to infected blood

A

HEP C

74
Q

true or false. personnel with HEP C should be restricted from work?

A

False

75
Q

What is the risk of HIV transmission?

A

0.3% for percutaenous; 0.01% for mucous membrane contact; less than 0.01% for non-intact skin contact

76
Q

what are risk factors for HIV transmission?

A

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

77
Q

True or false. You should test to establish HIV-AB immediately after exposure?

A

True

78
Q

When does varicella transmission occur?

A

1-2 days before symptom onset and until all lesions are crusted

79
Q

What are work restrictions for personnel who are vaccinated and exposed to varicella?

A

serotest. Exclude 10th to 21st day if seronegative

80
Q

VZIG is not recommended for who? Who is it recommended for?

A

-not recommended for immunocompetent personnel
-recommended for pregnant or immunocomprimised as PEP

81
Q

PEP for meningococcal is recommended when?

A

prolonged intensive contact with infected patients (no mask, mouth to mouth, endotracheal intubation, endotrachel tube management, or close examination of the oropharynx)

82
Q

when should PEP be administered for meninogococcal?

A

immediately after exposure

83
Q

True or false. lab personnel should get a pre-exposure meningococcal vaccine and booster every 5 years

A

True

84
Q

what antimicrobials are given for meningococcal?

A

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

85
Q

What are work restrictions for rubellaif you are exposed and not immune?

A

exclude from 7th to 21st day after exposure if not immune

86
Q

mumps is caused by which organism/virus?

A

paramyxovirus

87
Q

what is the mumps incubation period?

A

16-18 days

88
Q

what is the MMR vaccine schedule?

A

2 doses 28 days apart

89
Q

What constitutes measles immunity?

A

-2 doses; lab evidence; confirmation of disease; born before 1957

90
Q

True or false. You have presumptive immunity to mumps if before 1957 or earlier

A

True

91
Q

How soon after exposure should the measles vaccine be given?

A

72 hours

92
Q

Should scabicides or pediculcides prophylacticely be routinely offered?

A

no; only when there is transmission

93
Q

Does the CDC recommend prophylaxis for pertussis?

A

Yes; erythromycin, azithromycin, clarithromycin (trimethoprim and sulfamethoxodale an option)

94
Q

When is Influenza infectious?

A

From symptom onset to 7 days after

95
Q

who are high risk patients for herpes?

A

neonates, burn victims, immunocomprised, intensive care unit patients

96
Q

Which is less contagious zoster or varicella?

A

zoster

97
Q

When is localized zoster contagious?

A

when rash erupts until lesions crust

98
Q

You are immune to VZV when antibodies are

A

reactive

99
Q

Which virus can cause birth defects when women are infected during pregnancy?

A

CMW

100
Q

Who is the resesrvoir for CMV?

A

infants and immunocomprimised

101
Q

how is CMV spread?

A

direct contact with infectious body fluids

102
Q

Which virus causes 5th disease?

A

parvovirus

103
Q

how is parvovirus spread?

A

before the rash appears. Through contact with infected persons, fomites, large droplets

104
Q

are pregnant personnel at a greater infection risk for parvovirus?

A

no; but it can cause fetal death in the first half of pregnancy

105
Q

What are work restrictions for staff with MDROs?

A

if draining lesions, restrict from patient care and food handling

106
Q

what is the largest cause of HCP exposure to blood and infectious materials?

A

percutaenous injuries from sharps

107
Q

Define work practice controls

A

Practices that reduce the possibility of exposure by changing the way a task is performed

108
Q

Define non-employee

A

volunteers and contract workers not directly employed by the facility but authorized to provide services.

109
Q

Are pregnant women considered immunocomprimised?

A

no, there immunologic function is normal

110
Q

True or false. There is a decrease in cell-mediated immunity in the third trimester to viruses and pathogenic fungi

A

True

111
Q

Does varicella zoster in unimmunized women present a risk to the mother and neonate?

A

yes

112
Q

Pregnant women may ber estricted from caring for patients with which infections?

A

Parvovirus B19 and RSV receiving ribavirin aerosol

113
Q

Which vaccines are not recommended during pregnant?

A

live vaccines like rubella, rubeola, varicella, and smallpox

114
Q

healthcare acquisition of which diseases is unlikely for pregnant HCP?

A

toxoplasmosis and HSV

115
Q

Post exposure chemoprophylaxis is effective for pregnant HCP for which agents?

A

HIV, syphillis, meningitidis

116
Q

IPAC is the only preventative measures for which infectious agents?

A

-parvovirus B19
-CMV
-TB
-HCV

117
Q

which precautions are used for parvovirus?

A

droplet

118
Q

Which vaccines should a pregnant HCP have?

A

-MMR
-Varicella
-tetanus
-diptheria
-polio
-or evidence of having had the disease before pregnancy

119
Q

Which vaccines are contraindicated for pregnant women?

A

-HPV
-Influenza LAIV
-MMR
-Varicella
-zoster (shingles)

120
Q

Which vaccines have insufficient data for pregnant HCP recommendation?

A

pneumonococcal

121
Q

How is CMV transmitted?

A

sexual contact or direct contact with infected urine, saliva, semen, vaginal secretions, or breast milk.

122
Q

What are primary risks for infections about seronegative women for CMV?

A

-under 25
-multiple sexual partners
-exposure to young children (especially those at day care)

123
Q

Do HCP have an increased risk of acquisition of CMV infection?

A

No

124
Q

How does CMV usually spread?

A

asymptomatic primary and recurrent infections, multiple sites of excretion, prolonged and intermittent excretion, and excretion of virus despite presence of immunity

125
Q

HAV replicates in the ____, is excreted in the ____ and shed in the _____

A

liver; bile; stool

126
Q

When is HAV peak infectivity?

A

during the 2 weeks before jaundice onset or elevation of hepatic transaminases, when viral concentration in stool is the greatest

127
Q

How is HAV usually transmitted?

A

stool but blood can be a source for a short period of time

128
Q

Has maternal HAV transmission of the fetus been estbalished?

A

No

129
Q

What are some HAV infection risks during pregnancy?

A

-systemic infections
-spontaenous abortion
-preterm delivery

130
Q

What should be done if someone is not vaccinated and exposed to hep B?

A

begin the vaccine series at the time of exposure and administer hep B immune globulin ASAP, preferably within 24 hours

131
Q

What do you do if a person is vaccinated and exposed to hep B, but vaccine response is unknown?

A

perform a baseline test for anti-HBs

132
Q

When is baseline testing not necessary after hep B exposure?

A

if the person has not been vaccinated or vaccine response is known

133
Q

The average risk of HCV transmission after percutaenous exposure is ____ and ____ for mucocutaenous exposure

A

0.2%; 0%

134
Q

What is the HCV incubation period

A

2-24 weeks (average 6-7 weeks)

135
Q

is HBV infection during pregnancy dangerous?

A

Yes, it can result in severe disease for the mother, fetal loss, or chronic infection of the neonate if born alive

136
Q

is pregnancy a contraindication for hep B vaccination?

A

No

137
Q

What is the vaccination schedule for newborns born of HBsAg positive mothers?

A

administer HBIG 0.5ml IM and single antigen hep B vaccine at separate injection sites within 12 hours of birth

138
Q

Is there a vaccine or effective therapy for hep C during pregnancy?

A

No and there is nothing for the post natal period

139
Q

hep C infection during the first and second trimesters can cause

A

fetal hepatic injury

140
Q

how is hep C transmitted?

A

sexually, by exposure to blood via transfusion, sharing needles for intravenous drug use, percutaneous injury, rarely perinatal exposure

141
Q

Healthcare associated herpes is usually caused by

A

herpetic whitlow from now wearing gloves when contacting mucous membranes.

142
Q

humans are the sole natural host for what virus?

A

herpes

143
Q

are HPV vaccines recommended for pregnant women?

A

No

144
Q

what should a woman do if she gets pregnant after beginning the HPV vaccination series?

A

delay the rest of the 3-dose series until completion of pregnancy

145
Q

risk of percutaenous HIV transmission is increased with ________ and when _____________

A

hollow bore needles and when an increased volume of blood is injected.

146
Q

can pregnant HCP get PEP for HIV?

A

yes; treat them as any other person with an exposure

147
Q

True or false. Pregnant women are at an increased risk of severe illness from Influenza

A

True

148
Q

Influenza vaccine is recommended for all persons age what?

A

> 6 months

149
Q

get pregnant women get the MMR vaccine?

A

NO

150
Q

women should be advised to avoid becoming pregnant for _____ after getting an MMR vaccine

A

28 days

151
Q

what is the causative agent of erythema infectiosum?

A

parvovirus B19

152
Q

What is the risk of parvovirus to the fetal of a pregnant HCP?

A

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.

153
Q

How is parvovirus transmitted and what are the precautions?

A

-respiratory secretions during close contact
-droplet precautions

154
Q

what is the pertussis incubation period?

A

7-10 days

155
Q

What are the 3 phases of pertussis?

A
  1. catarrhal
  2. paroxysmal
  3. convalescent
156
Q

how is pertussis transmitted?

A

large respiratory droplets generated by coughing or sneezing

157
Q

most pertussis deaths occur in what age group?

A

less than 2 months old

158
Q

who is most likely to develop severe pertussis?

A

anyone younger than 12 months especially younger than 3 months

159
Q

can pregnant women get the varicella vaccine?

A

no

160
Q

when is varicella contagious?

A

1 day before rash onset until all lesions have crusted

161
Q

What is the most common complication of chickenpox?

A

chickenpox pneumonia. occurs in 15-50% of adults who do not get treated with antivirals (acyclovir)

162
Q

is acyclovir recommended for pregnant women with chickenpox?

A

Yes

163
Q

when is VZIG recommended for pregnant women?

A

when there is no evidence of immunity

164
Q

when should VZIG be administered as PEP?

A

ASAP, ideally within 96 hours

165
Q

What vaccines should HCP have?

A

-influenza (sep-May)
-Tdap (one time)
-Td (every 10 years)
-shingles
-varicella
-MMR
-Hep H

166
Q

how is the hep b vaccination series given?

A

3 series IM injections:
-2nd at least 4 weeks after first
-3rd 5 months after second

167
Q

After an exposure, when must hep b vaccination be offered?

A

within 10 days

168
Q

does a sharps safety risk assessment apply to residents who perform unassisted glucose monitoring?

A

No

169
Q

How long do employee files need to be kept?

A

For 30 years unless employment was <1 year

170
Q

Anti-HBc

A

present during and after infection

171
Q

anti-HBc IgG

A

chronic infections

172
Q

Anti-HBc IgM

A

recent infection

173
Q

what are the TB plan components?

A

-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.

174
Q

What are work restrictions for group a strep?

A

None unless personnel are epidemiology linked to transmission of the organism

LTC-CIP (9 decks)

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