Employee Occupational Health Flashcards
1
Q
Why OHP is important?
A
- Promotes awareness of occ health hazards to hcp
- regs look for safe hc env
- promotes safe env to give and receive care
2
Q
Elements of an OHP
A
1) Educate HCP
2) Partner with IP in monitoring and investigating potentially harmful infectious disease expsures and outbreaks
3) Care and follow-up for work related illnesses, exposures, and injuries
4) ID work related exposure risks and institute preventative measures
5) contain costs by preventing infectious diseases that result in absenteeism and disability
3
Q
First step to post exposure intervention
A
Verify the dx of the index case
4
Q
What is the next question once dx is confirmed?
A
Is the patient infectious?
5
Q
If the patient was infectious- what is the next question to address?
A
Was barrier technique absent or was there a breach in technique that would have lead to expsure?
6
Q
If there was a breach in technique or barrier technique was absent, what is the next question?
A
Who was exposed?
7
Q
For people that were exposed, what is the next question?
A
Is the individual susceptible?
8
Q
What to ask if the individual who was exposed is susceptible?
A
Does the disease have potential for further spread?
9
Q
If the exposed person is susceptible, but there is no potential for further spread, what next?
A
Monitor the employee for clinical symotoms
10
Q
If the exposed HCP is susceptible, and there is potential for futher spread, what next?
A
Ask if there are therapeutic measures for treatment?
11
Q
If there are therapeutic measures for the exposed, susceptible employee, what next?
A
Implement intervention measures
12
Q
If there are no therapeutic measures for the exposed, susceptible employee, what next?
A
Monitor employee for clinical symptoms and follow policy for restriction
13
Q
Source of TB exposure for healthcare personnel
A
laryngeal and pulmonary Tb
14
Q
When to educate HCP about TB?
A
Upon hire
annually
as needed
15
Q
What should TB education include?
A
- how it spreads
- signs and symptoms
- preventative measures (including fit testing for N95s)
16
Q
What specific recommendations and guidance does the CDC provide to help control the spread of TB in HC facilities?
A
- fit-testing
- dx and treatment for latent TB
- Facility respiratory protection programs
17
Q
First step to the TB control plan
A
- Assess an institutions TB risk by performing a TB risk assessment
18
Q
What does the TB risk assessment include?
A
- prevalence of recognized and unrecognized TB patients in the facility and the surrounding community
- patterns of TST conversions or positive blood assay for M. tuberculosis in employees (bamt)
19
Q
What are the risk classifications for TB?
A
- low risk
- Medium risk
- potential ongoing transmission
20
Q
How often does a facility need to complete a TB risk assessment?
A
Annually
21
Q
When does the CDC recommend testing for TB?
A
- upon hire
- if there is a suspected exposure
- if there is ongoing transmission in the facility
22
Q
Bacillii multiplication in latent and active TB
A
Active: active and multipliyng
Latent: inactive and contained
23
Q
TST and IGRA test results for latent and active TB
A
Active: Positive
Latent: positive
24
Q
Chest xray results for latent and active TB
A
Active: abnormal
Latent: normal
25
Sputum smears and culture for latent and active TB
Active: positive
Latent: negative
26
Symptoms of active and latent TB
Active: symptomatic
Latent: asymptomatic
27
Infectiousness of active and latent TB
Active: Infectious
Latent: Not infectious
28
Does latent TB require treatment?
Yes
29
Does active TB require treatment?
Yes
30
How long after initial infection with TB does the immune system limit additional multiplication of the bacteria
2-12 weeks
31
Why treat latent TB
Prevents TB from turning into active disease
32
Who should be included in the TB screening program?
All part-time, temporary, contract, and full-time HCP and LIP
Students and volunteers may need to be considered for the program as well
33
What does the TB screening include for HCP?
- individual risk assessment
- Symptom evaluation
- Testing
34
What are the two types of TB test?
- PPD (purified protein derivative)-based tuberculin skin test (TST)
- interferon-gamma release assay (IGRA)
35
What are the brands of IGRA?
1. QauntiFERON-TB Gold in-tube test (QFT-GIT)
2. T-Spot TB test
36
What is the benefit of IGRA testing?
Single visit to conduct the test and results are within 24 hours
37
TST process description
-0.1 ml of tb PPD into forearm
- read between 48-72 hours later
- place again if not read at 72 hours
38
How many TSTs are needed if it's a new hire with no documented negative TST tests in the past 12 months?
two
39
What is the gold standard for TB testing?
IGRA
40
Rational behind IGRA
Persons infected with M. TB will release interferon gamma (IFN-g) when mixed with antigens derived from M. TB
41
Reasons BCG not administered in U.S.
- low prevalence of M. tuberculosis
- variable effectiveness against adult pulmonary TB
- potential interference with TST
42
Preferred test for BCG vaccinated people
IGRA
43
What happens if an HCP screens positive for TB?
-Chest xray
44
What happens if a person is IGRA positive and chest xray negative?
provide info on symptoms that are suggestive of TB and instruct them to report
45
What happens if a person is IGRA positive and xray is abnormal?
- take exposure history to determine if the infection is occupational or community associated
- refer to hcp for therapy
- follow regs for follow up CXR
46
Do chest xrays need to be repeated for latent TB cases?
Only if they become symptomatic
47
If TB conversion identified, who to refer HCP to
Provider for consideration of preventative therapy
48
What to do if there is a potential TB exposure..
Was the exposure unprotected? (N95 or higher not worn)
If yes- administer TST at time of exposure and again in 12 weeks
49
Will an employee with latent TB require CXR after exposure?
Not unless they have symptoms
50
What are the symptoms of TB?
Bloody cough that is long-term
fever
chest pain
chills
weight loss
fatigue
night sweats
51
When should employees with TB be excluded from work?
They have laryngeal or pulmonary TB
52
When can excluded staff with active TB return to work?
1) they are responding to anti-TB treatment
2) 3 consecutive sputum tests collected 8-24 hours apart are all negative
3) documented clearance to be non-infectious by a physician knowledgeable about managing TB
53
Requirement from OSHA that requires employers to provide a program for HCP working in an environment that could require a respirator
Respiratory Protection Program
54
Who oversees the respiratory protection program at the hc facility?
a program administrator who is qualified by appropriate training or experience and conduct required evaluations of program's effectiveness
55
How often must the employer provide training to staff about the respiratory protection program?
- upon hire
- annually
- as needed
56
What must the respiratory protection program training include?
- how to select the correct respirator
- when respirator needed
- how to maintain and use the respirator
57
Parts of the respiratory protection program
1) written program
2) respirator medical evaluation
3) trainnig
4) fit testing
5) recordkeeping
58
Logistics of the respiratory program
- procedures for selecting respirators
- staff medical evaluations
- fit testing procedures
- procedures for proper use, storing, and discarding of respirators
59
Education - respiratory program components
- respiratory hazards during routine and emergent situations
- proper use of respirators- donning and doffing and fit checks
- limitations of respirators
- maintenance and care of equipment
60
When should fit-testing happen?
- prior to use
- annually
-as needed
61
What are the two types of fit testing?
Qualitative fit test (QLFT)
Quantitative fit test (QNFT)
62
This fit test uses smell or taste and results in pass or fail
qualitative fit test
63
This fit test uses a machine to measure the actual amount of leakage into the mask
Quantitative fit test (QNFT)
64
Do PAPRs require fit testing?
No
65
Example of "as needed" for fit testing
- facial/ physical changes such as extreme weight loss or gain
66
How often do HCP need to perform a seal check for their respirator?
with each use
67
Name for chicken pox
Varicella zoster virus
68
Name for shingles
Herpes zoster virus
69
How is chickenpox spread?
- Person to person by direct contact
- inhalation of aerosols from skin lesions (chickenpox or shingles)
- infected respiratory secretions?
70
Contagious window for chickenpox
1-2 days before rash
71
How long do people with chickenpox remain contagious?
until all lesions are dry and crusted over
72
Incubation periods for chickenpox
14-16 days (range 10-21 days)
73
How chickenpox lesions present in vaccinated people and when they are contagious
- lesions do not crust over
- contagious until there are no new lesions that have appeared for 24 hours
74
What age group is a prodrome of fever and malaise 1-2 days before chickenpox common in: kids or adults?
Adults
75
What is the R0 of chickenpox?
8-12
76
evidence of varicella immunity in adults
- history of clinical dx and lab evidence of immunity (titer)
- documentation of age-appropriate vaccination
77
Recommendation for varicella vaccination who do not have evidence of immunity
Vaccinate
78
First step after varicella exposure
Verify dx in index case
79
Second step after varicella exposure once dx confirmed
test immunity of HCP who are exposed, immediately after exposure to check for antibodies
80
What to do if the HCP exposed to varicella does not have immunity
exclude from work from day 10 - day 21 postexposure
81
If chickenpox symptoms develop in an exposed person- how long to exclude?
until all lesions are dry and crusted over
82
What can be used in HCP exposed to chickenpox that are immunocompromised or pregnant
VZIG
83
How does VZIG impact exclusion?
Exclude from day 10- day 28
84
How are N. meningitidis transmitted?
respiratory droplets
85
Where do N. meningitidis attach to and multiply?
Nasopharynx and oropharnyx
86
What menningococcal disease patients can transmit meningitis?
- meningococcemia
- meningococcal meningitis
- lower resp tract infection with N. meningitidis through handling lab specimens
87
First line of defense for staff against meningococcal disease
Vaccinate high-risk HCP, including lab personnel who handle N. meningitidis
88
How often to offer lab staff boosters for meningococcal disease?
Every 5 years
89
What does unprotected contact to N. Meningitidis entail?
NO MASK and
mouth to mouth
endotracheal intubation
endotracheal tube management
close examination of oropharynx
90
PEP for meningococcal disease exposure
- rifampin every 12 hours for 2 days
- single dose cipro
- single dose ceftriaxone
91
What two meningicoccal PEP drugs are NOT recommended for pregnant women?
Cipro
Rifampin
92
Documentation of immunity for rubella
- one dose of live rubella vaccine
- lab evidence of immunity
93
Documentation of immunity for measles
- documentation of 2-step MMR
- lab evidence of immunity
- lab confirmation of disease if born before 1957
94
documentation of mumps immunity
- documentation of 2-step MMR
- lab evidence of immunity
- lab confirmation of disease if birth before 1957
95
What are the immunization recommendations for HCP born before 1957 who do not have lab evidence of immunity?
dose of MMR
96
Who should NOT receive the MMR vaccine?
Pregnant women or women who plan to become pregnant in the next 28 days
97
who should receive the MMR vaccine?
Anyone without evidence of immunity and not pregnant
98
Incubation period for measles
11-12 days
99
Prodrome for measles
2-4 days
100
Exposure to rash onset measles
average 14 days (range 7-21 days)
101
infectious period measles
4 days before and 4 days after rash onset
102
How measles is transmitted
Respiratory droplets
airborne in closed areas for up to 2 hours
103
What tissue does measles replication occur in?
Variety of tissues, including the immune system and nervous system
104
What is the primary site of infection for measles?
Alveolar macrophages or dendritic cells
105
Mumps incubation period
16-18 days (range 12-25 days)
106
Transmission of mumps
Respiratory droplets
107
Replication of mumps
Nasopharynx and regional lymph nodes
108
Rubella incubation periods
14 days (range 12-23 days)
109
Transmission of rubella
respiratory droplets
110
Where rubella replicates
Nasopharynx
Regional lymph nodes
111
Exclusion for measles
Day 5- Day 21
112
Exclusion for mumps
Day 9- day 26
113
Exclusion for rubella
day 7- day 21
114
PEP for measles
administer vaccine to susceptible HCP within 72 hours of exposure
115
Transmission of pertussis
Droplet
116
Incubation period of pertussis
5-10 days
117
Vaccine recommendations for adults for pertussis
Adults should receive Tdap initially, then a Td or Tdap booster every 10 years
118
Who is at the greatest risk for serious illness and death from pertussis?
Infants less than 1 year old
119
What are the 3 stages of pertusssis?
Catarrhal stage
Paroxysmal stage
Convalescence stage
120
Describe the catarrhal stage of pertussis
lasts 1-2 weeks
Insidious onset, similar to common cold
121
Describe the paroxysmal stage of pertussis
lasts 1-6 weeks
More severe cough and may experience paroxysms
122
Describe the convaleescensce stage of pertussis
Lasts weeks to months
gradual recovery
123
Communicable period of pertussis
Onset - 3 weeks after start of paroxysmal cough
124
PEP for pertussis exposure
Erythromycin
azithromycin
clarithromycin
125
Alternative PEP pertussis exposure
Trimethoprim-sulfamethoxazole (TMP-SXT)
126
Should exposed personnel to pertussis be excluded?
no, not unless they develop symptoms
127
When to exclude exposed HCP to pertussis and how long
if symptoms develop, for 21 days from onset of cough OR until 5 days after appropriate therapy
128
Does immunity status matter for Pertussis PEP?
No
129
Contagious window for flu
1 day before symptom onset- 7 days after (can be longer for immunocompromised)
130
Transmission of flu
respiratory droplets
131
Incubation period for flu
2 days
132
Exclusion of employee with flu
Stay home until at least 24 hours after their fever is gone without the use of fever reducing meds
133
PEP for flu?
Not usually recommended but antivirals may be given during outbreak sitations
134
What factors impact the burden of flu?
- Virus circulating
- Vaccine effectiveness
- Vaccine compliance
135
best way to prevent flu
get flu vaccine each year
136
High-risk groups for complications for influenza
- Seniors
- Infants
- Young children
- Persons with chronic medical conditions
- Pregnant women
137
Joint commission requirements for annual influenza vaccination program
1) provide education at least annually
2) provide vax free of charge
3) make vax accessible to staff
4) goal to improve flu vax rates in IP plan
5) written description of how flu vax rates were determined for faciltiy
138
How long it takes flu antibodies to develop
2 weeks
139
What are the BBPs?
Hep B, Hep C, HIV
140
What does probability of infection with a BBP depend on?
- route of exposure
- Concentration of infectious virions in the implicated body fluid
- volume of infective material transferred
- for Hep B- susceptibilty
141
Types of exposure to BBP
- percutaneous injury
- contact of mucous membrane or nonintact skin with blood or body fluids that are potentially infectious
142
What is the risk of BBP to HCP from:
CSF
Synovial fluid
Pleural fluid
Peritoneal fluid
Pericardial fluid
Breast milk
Amniotic fluid
not assessed
143
Precautions to use to prevent BBP exposure
Standard precautions
144
How to prevent percutaneous injuries
-Implement safe work practices
-Ensure staff educated to handle/ dispose of sharps
-Ensure staff know how to report exposures
145
Exposure prevention: vaccination
Vaccinate staff against Hep B
146
Is HBV stable in the environment?
Yes, resistant to drying, simple detergents, and alcohol
147
How long can HBV remain viable in the environment?
7 days or longer at room temp
148
Does visible blood need to be present for infectious levels of HBV DNA?
Np
149
Transmission of HBV
Percutaneous/ mucousal exposure
Equip that is not properly disinfected
150
Risk of HBV infection from a needlestick injury if HBeAg positive?
37-62%
151
Risk of HBV infection from needlestick injury if HBeAg negative?
23-37%
152
What is the presence of HBeAg indicative of?
High infectivity
153
What does anti-HBe correlate with?
The loss of replicating virus and lower levels of virus
154
HBV incubation periods
90 days for jaundice
155
Ratios of adults that are symptomatic/ asymptomatic with acute HBV infection
Asymptomatic (2/3) or symptomatic (1/3)
156
Symptoms HBV
Jaundice
Dark urine
Scleral icterus
10x normal ALT and AST
157
Time from exposure to onset of elevated liver function tests for HBV
60 days
158
How long does it take HBsAg to show up in newly infected persons?
6-60 days, mean 30 after exposure
159
When does anti-HBC appear?
At onset of symptoms of elevated liver tests
160
When does anti-HBs develop?
After HBV recovery, within 3-4 months
161
Which test demonstrates immunity for Hep B
Anti-HBS (only see with recovery and vax)
162
Persistence of HBsAg for 6 months after dx of acute HBV
progression to chronic HBV
163
HBsAg- negative
anti-HBc- negative
anti-HBs- negative
suceptible
164
HBsAg- negative
anti-HBc- positive
anti-HBs- positive
Immune due to natural infection
165
HBsAg- negative
anti-HBc- negative
anti-HBs- positive
Immune due to Hep B vax
166
HBsAg- Positive
anti-HBc- positive
IgM anti-HBc- positive
anti-HBs- negative
Acute infection
167
HBsAg- positive
anti-HBc- positive
IgM anti-HBc- negative
anti-HBs- negative
chronic infection
168
HBsAg- negative
anti-HBc- positive
anti-HBs- negative
Unclear (resolved, false positive, low level, resolving acute)
169
What is the PEP for HBV exposure?
Hep B vax
170
OSHA BBP standard requires hc facilities to provide this vaccine for free to anyone who does not have previous immunity and is at risk of exposure
Hep B
171
what type of vax is Hep B?
recombinant DNA
3 shots
172
when should HCP be tested for anti-HBS after completing the series? if no response?
1-2 months
repeat the series
173
What to do after HBV exposure
- Unvax worker - initiate 3 vax series
- When HBIG indicated, administer within 24 hours
174
% of HBV vax recipients that develop a protective antibody response
90%
175
Adults that develop a protective antibody response from the HBV vaccine are protected from...
Clinical disease and chronic infection
176
Are boosters needed for HBV?
No
177
Most common chronic bloodborne infection in the U.S.
Hep C
178
Incubation period for acute HCV infection
2-24 weeks (averages 6-7 weeks)
179
How is HCV transmitted?
exposure to infected blood
180
What increases HCP risk of HCV exposure?
Injuries resulting in deep punctures or wounds with bleeding
Procedures involving a needle in a patient's artery or vein
181
How often (%) does chronic HCV develop?
75-85% of cases
182
How often does cirrhosis develop in HCV positive patients?
10-20%
183
Time period for liver effects from HCV
20-30 years
184
Recommendation for HCV treatment
Evaluate presence and severity of chronic liver disease
185
What does successful HCV treatment do?
Eliminates viremia
Reduces potential for transmission
Prevents further liver disease
186
How often is screening for HCV recommended?
At least once for adolescents and adults aged 18-79
187
Recommendation to prevent HCV infections
Screening and testing blood donors
viral inactivation of plasma
Risk reduction counseling
Screening people at risk for HCV
Standard precautions
Safe work practices
188
Is there PEP for HCV?
No
189
Recommendations for postexposure management to HCV
Early detection and more frequent testing
- refer to specialist for medical management
190
When to begin testing for HCV if blood/ bodily fluid exposure occurs
ASAP (within 48 hours)
191
Why test ASAP after blood/ body fluid exposure occurs?
- Helps with stress and anxiety about the exposure plus reduces loss to follow up
- Antiviral therapy my be most effective early in HCV infection
192
Transmission of HIV
Exchange of body fluids
193
What is the risk for HIV after percutaneous or mucosal exposure
0.3% after percutaneous injury
0.09% after mucosal exposure
194
Incubation period HIV
weeks to months
195
Symptoms of initial HIV infection
Flu-like febrile illness
196
Does the EIA Antibody screening for HIV always have a positive result when there are early symptoms?
No
197
What tests are appropriate for early HIV infection?
viral antigen (P24) and nucleic acid amplification testing
198
What happens to CD4 counts in HIV patients?
Decrease over time (years)
199
When is the HIV patient at risk for serious opportunistic infections?
when CD4 count drops below 200 cells/ mm3
200
How many classes of anti-retroviral agents are available to treat symptoms related to HIV infection or CD4 cell counts <350 cells/ mm3?
6
201
What testing needs to happen prior to initiating anti-retroviral therapy?
- HIV drug resistant testing
- screen for HLA-B*5701 before an abacavir- containing regimen (gene that predisposes to allergic reaction)
202
Precautions to prevent HIV exposure
Standard
203
When should HIV anti-retroviral treatment be started, regardless of CD4 count?
Pregnant women
Patients with HIV associated nephropathy
Patients coinfected with HBV when treatment indicated
204
HIV Postexposure testing
Baseline and follow up testing for 6 months after exposure (ie immediately, 6 weeks, 3 months, and 6 months), if positive start anti-retroviral meds
205
After HIV exposure - steps
- Counsel
- HIV testing
- Determine source's HIV status (viral load)
- Select PEP regimen based on risk of infection by exposure
206
What devices are most frequently associated with bbp exposures?
Blood-filled, hollow bore needles
207
Recommendations for preventing needlestick injuries
- use safety devices
- avoid injecting blood into vacuum tubes using conventional syringes
- Retract finger/ heel prick lancets
208
example needless access equipment
Blunt cannula
valve systems
209
preventing injuries from scalpels
1) alternate cutting methods when appropriate
2) scalpels with safety features (retracting blade or shield)
3) Hands free pass of instruments
210
Engineering controls for IV catheters
1) Protective shield for the stylet before or during it's withdrawal from the catheter
2) implement safety IV catheters
3) Gloves worn during IV insertion procedure
4) puncture-resistant sharps disposal container
211
Two types of scabies
Conventional and Norwegian (crusted)
212
Transmission of scabies
prolonged skin-to-skin contact and unprotected contact with bedding/ linens from infected patients
213
Precautions for scabies
contact precautions
214
How to respond to exposed personnel to scabies
Evaluate for signs and symptoms of mite infestation
215
If HCP has confirmed or suspected scabies
exclude from duty until appropriate treatment is given and is effective
216
What are the different types of lice?
Human head louse
Human body louse
Pubic louse
217
Risk of HCP transmission of head and body lice? Pubic lice?
Unlikely, very unlikely
218
what is pediculosis
Infestation with lice
219
Should exposed personnel get pediculosis treatment?
Only if they have evidence of infestation
220
Should routine prophylactic scabicides or pediculicides be given?
No, not unless transmission has occurred
221
Should employees with pediculosis be excluded?
Yes- exclude from duty until they receive appropriate initial treatment and it is found to be effective
222
What to do: employee has oral HSV
review and case by case basis- is there any transmission potential to high-risk patients?
223
What to do if employee has herpetic whitlow
1) Exclude from patient care until lesions health
224
What causes herpetic whitlow?
Touching an HSV sore or cold sore of an infected person
225
How does herpetic whitlow present?
Mostly on fingers and is painful
226
What to do if employee has herpes zoster virus (shingles)
Consider excluding personnel until lesions are dry with scab, but person with shingles should not provide care to susceptible patients with high risk for severe varicella
227
What to do if employee has CMV
No need for reassignment or exclusion
228
What to do if pregnant employee exposed to Parvovirus B19 (Fifth disease)
Pregnant personnel should contact their provider ASAP
229
which human herpes virus is CMV?
HHV 5
230
How is CMV transmitted?
Direct contact with infectious body fluids
231
Precautions for CMV
Standard
232
Concern for CMV
Pregnant women
233
How is parvovirus transmitted?
Contact with infected persons, fomites, or large droplets
234
What is the concern about pregnant women exposed to Parvovirus?
If acquired during the first half of pregnancy, risk of fetal death increased
235
What to do if employee has RSV
Exclude from caring for high-risk patients
236
Transmission of RSV
large droplets during close contact
237
What to do if HCP has acute respiratory illness?
Exclude from caring for high-risk patients
238
What to do if HCP exposed to MDRO
no recommendations for exclusion, except if there is an epi-link transmission BUT need to determine based on endemic organisms and policy
239
Prevention of MDRO: how often to educate
- on hire
- annually
- as needed
240
What to do: staff has a draining skin lesion
Exclude from patient care activities and food handling
241
What healthcare exposures are associated with adverse outcomes for pregnant healthcare personnel and/or their fetus
CMV
Parvovirus B19
Herpes simplex virus
Syphilis
242
What diseases should HCP be immunized for PRIOR to conception
measles, mumps, rubella
Ruboela
Hep B
Varicella
243
What precautions will protect pregnant women against most exposures
Standard Precautions
244
Who does non-employed HCPs include?
- volunteers
-contract workers
- other individuals not employed directly by the facility
245
Non-employed HCP should:
- understand the principles of transmission and prevention of disease within the framework of their duties
- adhere to requests for prescreening health records including immunizations and TB screening
