Hospital Occupational Infections Flashcards
1
Q
What are the vaccine-preventable diseases for healthcare personnel (HCP)?
A
- Measles, Mumps, Rubella
- Varicella
- Influenza
- COVID-19
- Pertussis
- Hepatitis B
- Tetanus
- Meningococcal *(job specific) *
- Rabies (job specific)
- Vaccinia/Mpox (job specific)
Live vaccines are indicated for Measles, Mumps, Rubella, and Varicella.
2
Q
Which vaccine-preventable diseases for HCP are “job specific”?
A
- Meningococcal
- Rabies
- Vaccinia/Mpox
3
Q
Which vaccine-preventable diseases for HCP are live vaccines?
A
MMR
Varicella
4
Q
What organism causes Measles?
A
Rubeola virus
Measles is highly contagious and can lead to severe complications.
5
Q
What are the clinical manifestations of Measles?
A
- High fever
- Malaise
- Cough
- Coryza
- Conjunctivitis
- 2-3 days after: Koplik’s spots (tiny white spots in mouth)
- 3-5 days after: Rash
3 C’s
6
Q
When does the measles rash appear and what direction does it spread?
A
3-5 days after symptoms begin
head > toe
7
Q
What is the incubation period for Measles? Recovery?
A
7 – 14 days (typically 11 – 12 days)
Recovery 7-10 days after sx onset
Symptoms begin with fever and the ‘three Cs’ (cough, coryza, conjunctivitis).
8
Q
What are some complications associated with Measles?
A
- Pneumonia (most common cause of death in young children)
- Encephalitis
- Death (1-3:1000, respiratory/neuro complications)
- Rare: subacute sclerosing panencephalitis (SSPE), occurs 7–10 years after measles infection and leads to fatal degenerative disease of CNS
9
Q
Which populations are at increased risk for measles?
A
Children younger than 5
Adults older than 20
Pregnant
Immunocompromised individuals
10
Q
How is Measles diagnosed?
A
- Throat swab for PCR
- Blood for IgM antibodies
11
Q
What should you do if you suspect a measles case?
A
- Isolate the patient! Notify DPH!
- Contagious 4 days before to 4 days after the rash appears (day 0)
- Airborne precautions: can remain infectious in the air for up to 2 hours; fitted N95
12
Q
What is the post-exposure prophylaxis (PEP) for Measles?
A
- 5th day after first exposure until 21st day after last exposure… (daily monitoring for s/sx)
- MMR vaccine within 72 hours of exposure
- OR: Immunoglobulin within 6 days of exposure
Quarantine is required from the 5th day after the first exposure until the 21st day after the last exposure.
13
Q
What virus causes Mumps?
A
Mumps virus
Symptoms include fever, headache, and parotitis.
14
Q
What are the symptoms of mumps?
A
- prodrome (fever, HA, myalgia, tired, loss of appetite)
- parotitis–painful/swollen salivary glands (puffy cheeks, tender/swollen jaw), unilateral or bilateral
- resolve within 10 days of onset
15
Q
When is mumps infectious?
A
2 days before to 5 days after parotitis onset
Exclude HCP with mumps infection from work until 5 days after onset of parotitis.
16
Q
Complications of mumps?
A
- unilateral deafness in pre-vaccine era (also aseptic meningitis, encephalitis)
- orchitis, oophoritis, pancreatitis, hearing loss, meningoencephalitis
17
Q
Post-exposure for Mumps
A
- If exposed HCP with no evidence of immunity: start/complete vaccination series (does not prevent mumps after exposure…)
- Exclude from work from 10th day through 25th day after last exposure
18
Q
When were measles and rubella eliminated?
A
2000
2004
19
Q
What is the incubation period for Mumps?
A
12–25 days after infection
20
Q
What are the symptoms of Rubella?
A
- Rash (lasts a median of 3 days)
- w/wo mild fever, lymphadenopathy
- Arthralgia or arthritis (in up to 70% adult women)
25% to 50% of infections are asymptomatic.
21
Q
What is known as German measles or 3-day measles?
A
Rubella
22
Q
What is the incubation period for Rubella?
A
17 days (range of 12 to 23 days)
23
Q
When is Rubella infectious and when is it the most contagious?
A
From 7 days before to 7 days after rash appears. Most contagious when the rash is erupting.
Exclude HCP with rubella infection from work until 7 days after rash appears.
24
Q
Post-exposure for Rubella for HCP with no evidence of immunity?
A
Exclude from work from the 7th day after the first unprotected exposure through the 23st day after the last exposure
25
What complications can occur from Rubella?
* Thrombocytopenic purpura (rare)
* Encephalitis (rare)
* miscarriage or Congenital Rubella Syndrome
26
What is Congenital Rubella Syndrome?
Serious birth defects in newborn: cataracts, cardiac defects, can't hear
## Footnote
If a woman is infected while pregnant
27
What is the incubation period for Varicella (Chickenpox)?
14 to 16 days (range of 10 to 21 days)
28
What are the symptoms of varicella? How long do they usually last?
* mild prodrome of fever and malaise 1–2 days before rash onset (esp. adults)
* rash often the first sign of disease in children (macular > papular > vesicular > crusting... chest/back/face first)
* symptoms typically last 4 to 7 days
## Footnote
Exclude from work until all lesions **dry and crusted**.
29
What are complications associated with Varicella?
* Pneumonia
* Encephalitis
* Cerebellar ataxia
* Infection of skin lesions
## Footnote
VZV is a herpes virus that can cause severe complications. Latency.
30
What forms of proof of immunity are accepted?
* Written record (month/year) of vaccination
MMR/V, 2 doses, 28 days apart
MMR >12 mo old
* Blood titer
31
What type of organism causes tuberculosis?
bacteria *Mycobacterium tuberculosis*
## Footnote
Airborne transmission, goes to the alveoli
32
What ar the symptoms and test findings of Latent Tuberculosis Infection (LTBI)?
* no symptoms or physical findings suggestive of TB
* positive TST or IGRA
* normal CXR
* negative respiratory smear, culture
33
What are the symptoms and test findings of active TB?
* fever, cough, NS, weight loss, fatigue, hemoptysis, decreased appetite
* TST or IGRA usually positive
* CXR usually abnormal
* respiratory culture positive (smear 50%)
## Footnote
IGRA = QuantiFERON, (Interferon Gamma Release Assay)
34
What is the lifetime risk of LTBI reactivation?
10%
35
What is the primary cause of U.S. TB cases in the U.S.?
More than 80% of U.S. TB cases are attributed to reactivation of LTBI
## Footnote
10% lifetime risk of reactivation.
36
What are key elements to TB infection control?
* Administrative measures, engineering controls, PPE
* Risk assessments - written TB control plan
* Early i.d. and management of active TB cases
* TB screening programs for HCWs, no annual testing anymore
* annual HCW training (travel)
* evaluation of TB infection-control programs
## Footnote
Early identification and management of active TB cases are crucial.
37
What increases an individual's risk for TB?
* Residence > 1 month in a country with a high TB rate
* Current or planned immunosuppression
* Close contact with someone who has had infectious TB disease since last TB test
## Footnote
Yes = +risk at PPE (baseline); if all RA neg - low risk - second confirmatory test neg - no tx; pos - LTBI tx (also if RA pos)
38
New elements of TB screening programs for HCW?
* Individual TB risk assessment at baseline (sx eval, test)
* serial screening not routinely recommended
* annual TB education for HCP, including info about TB exposure risks
* LTBI treatment is encouraged! or: annual sx screen
* confirm positive in low risk individuals, *possible false pos* (negative individual risk assessment)
## Footnote
vs. referral to PCP to determine LTBI tx indicated; Goal = rule out active TB
39
How many tests for an adequate TB baseline?
2-step if TST (ideally with a different test)
40
Risk factors to progression to active TB?
* immunocompromised (HIV)
* infection in past 2 years
* children under 4
* h/o untreated TB
* history of prior BCG = protective
41
What does the Tuberculin Skin Test (TST) measure?
**immune response** to *M. tb* exposure, **indirect test** of infection
## Footnote
TST uses Purified-Protein Derivative (PPD) tuberculin products.
42
What are the methods of testing for TB infection?
* Tuberculin skin test (TST) = in vivo
* Interferon gamma release assays (IGRA) = in vitro (no risk of reaction from BCG... easier, no f/u)
## Footnote
Neither method can differentiate LTBI from active TB disease. Both indirect.
43
What are the two types of interferon gamma release assays (IGRA)?
QuantiFERON®–TB Gold Plus and T-SPOT®.TB test (T-Spot)
## Footnote
Both tests cannot differentiate latent TB infection (LTBI) from active tuberculosis disease.
44
What is the purpose of a symptom screen in TB testing?
It should be done for everyone at the time of testing and is the only screening method available for those with LTBI.
45
What is the composition of Purified-Protein Derivative (PPD)?
Mixture of > 100 proteins shared by:
* M. tb complex organisms
* M. bovis BCG
* Nontuberculous mycobacteria, such as MAC.
46
What are the two brands of PPD tuberculin products licensed by the FDA?
TUBERSOL® and APLISOL®
## Footnote
TUBERSOL® is from Sanofi Pasteur Limited and APLISOL® from JHP Pharmaceuticals, LLC.
47
Describe the Mantoux technique for the Tuberculin Skin Test (TST).
Inject 0.1 ml (5 TU) intradermally on the volar surface of the lower arm using a 27-gauge needle at a 5- to 15-degree angle.
48
When should the reaction of the TST be measured?
At 48–72 hours after administration, induration
## Footnote
delayed hypersensitivity; never on Thursdays!
49
What does induration refer to in the context of TST results?
The raised, hardened area at the injection site measured in **millimeters**.
## Footnote
NOT the red/erythema
50
What is considered a positive TST result for HIV-infected persons?
≥5 mm induration
51
When is >10 mm considered a positive TST result?
Recent arrivals from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings (e.g. HCW)
Mycobacteriology lab personnel
Children less than 5 years of age, or children and youth exposed to adults at high risk
## Footnote
increased risk of progression: infection in past 2 years, h/o untreated TB
52
When is a positive TST considered >5 mm?
HIV, recent contacts of infectious TB, fibrotic changes on CXR c/w prior TB, organ transplants patients, immunosuppressed
## Footnote
(immigration)
53
What is considered a positive TST result for people with no known risk factors for TB?
> 15 mm
54
What is a potential cause of a false-positive TST result?
Contact with nontuberculous mycobacteria or vaccination with BCG.
55
What is the risk of false negatives in TST?
Can be as high as 20-30% in patients with confirmed TB within 8 weeks of exposure.
56
What is the role of interferon gamma in the immune response to TB?
It is critical for innate and adaptive immunity against TB, activating macrophages and regulating cell-mediated immune response.
## Footnote
IGRAs use whole blood to measure Interferon gamma release in response to TB antigens
57
What is the significance of QuantiFERON®–Gold In-Tube test?
Developed to address limitations of early IGRAs requiring processing within a few hours of collection.
## Footnote
QuantGold: blood into 4 tubes, labeled with antigen
T-spot: 1-2 tubes, wells w/ Ab against IG...
react to antigens in tube or in wells
58
What do the newer QFT-Gold Plus tubes measure?
TB1 measures CD4 T cell response and TB2 measures CD4 and CD8 T cell responses.
Positive control
Negative control
59
What is the interpretation of results from QFT-Gold Plus?
**Result = TB response - Nil**
Nil less than 8, TB1/TB2 minus nil less than 0.35 and less than 25% of nil
## Footnote
Neg = mitogen - nil less than 0.5, TB1 + TB2 - nil less than 0.35 or = 0.5 and less than 25% of nil
60
What is the preferred method for diagnosing LTBI in individuals over 5 years old according to recent guidance?
IGRA rather than TST.
61
What are the treatment regimens for LTBI?
* Isoniazid (INH) and Rifapentine (RPT): 3 months, once weekly, 12 doses
* **Rifampin (RIF): 4 months, daily,** 120 doses
* Isoniazid (INH): 6 or 9 months, daily or twice weekly.
## Footnote
0:58 in Feb 7, 2025 voice memo
62
What is the Bloodborne Pathogen Standard?
29 CFR1910.1030, defines bloodborne pathogens as pathogenic microorganisms present in human blood that can cause disease.
63
What are considered bloodborne pathogens?
HIV
**Hep B**
Hep C
Syphilis, malaria, measles, varicella, CMV, Zika, etc.
64
What should be done immediately after a **skin exposure** involving **non-intact skin**?
## Footnote
needlestick, scratch injury, broken skin (dry, eczema)
Thoroughly wash the wound with soap and water for 15 minutes. +antiseptic scrub of exposed skin surfaces
65
Is blood contact with intact skin viewed as an exposure?
No.
66
What are infectious body fluids?
Blood, Semen/vaginal secretions, CSF, synovial, pleural, peritoneal, pericardial, and amniotic fluid
## Footnote
OPI (other potentially infectious)
67
Between HBV, HCV, and HIV, which has the highest risk of transmission?
HBV at 6-30%
## Footnote
vs. 1.8, now 0.2% for HCV
68
Is urine, saliva, or sputum considered an infectious fluid?
No, not without visible blood
stool, emesis, nasal discharge, tears, sweat
## Footnote
generally not considered infectious
69
What is the risk of HIV transmission via percutaneous exposure?
Approximately 0.3%.
## Footnote
0.09% or less with mucous membrane or non-intact skin. Last in 1999 (lab setting).
70
Higher risk of HIV?
Deep injury w/ hollow-bore, blood-filled needle (advanced disease or high viral load)
71
What does the Massachusetts HIV Consent Law require?
Verbal informed consent before testing for HIV and written consent for disclosure of test results.
72
What is the preferred regimen for post-exposure prophylaxis (PEP) for HIV?
**Raltegravir** 400 mg BID PLUS **Truvada** (300 mg TDF + 200 mg FTC).
73
What is the significance of the newer formulation of Tenofovir (TAF)?
Less kidney and bone toxicity compared to the original formulation (TDF).
74
What is the efficacy of the hepatitis B vaccine?
95% effective in preventing infection.
## Footnote
Complete series + positive titer = immune
75
What does the term 'infectious body fluids' include?
* Blood
* Semen and vaginal secretions
* Cerebrospinal fluid
* Pleural fluid
* Peritoneal fluid
* Pericardial fluid
* Amniotic fluid.
76
T or F: Risk of Hep B transmission via needlestick is higher when HBeAg is positive?
True
77
When did the hepatitis B vaccine become available in the United States? When did the ACIP recommend it for healthcare professionals?
1981
1982
78
In what year did the hepatitis B vaccine become part of routine infant vaccination schedules?
1991
79
What is the recommended regimen for the hepatitis B vaccine?
3-dose regimen at 0, 1, and 6 months
80
What combination vaccine contains inactivated HAV and recombinant HBV?
Twinrix
81
What is the 2-dose recombinant and adjuvanted regimen for hepatitis B vaccination?
At 0 and 1 months
## Footnote
HEPLISAV-B
82
What is the effectiveness range of combining HBIG and initiation of the hepatitis B vaccine series at birth for perinatal exposure?
85%--95% effective
## Footnote
HBsAg-positive, HBeAg-positive mother
83
What is the estimated protection from HBV infection when multiple doses of HBIG are initiated within 1 week following percutaneous exposure?
75% protection
84
What does HBIG stand for?
Hepatitis B Immune Globulin
85
What is the source of HBIG?
Prepared from human plasma known to contain a high titer of antibody to HBsAg
86
What should be performed as soon as possible after a potential HBV exposure?
Testing
87
What testing should be done for a non-immune employee exposed to a positive Hepatitis B source patient?
* Test Source for Hep B s Ag
Employee:
* Baseline: Obtain Hepatitis B ‘core’ antibody
* 6 month follow-up: Obtain Hepatitis B s Ag and anti-Hepatitis B c AB
88
What is the risk of Hepatitis C transmission if the source patient has Hepatitis C?
Approximately 1.8%
89
What is the recommended testing timeline for HCP after exposure to Hepatitis C?
* Baseline: anti-HCV with reflex to a NAT if positive
* Follow-up: NAT at 3–6 weeks postexposure, final test for anti-HCV at 4–6 months
90
What are some prevention strategies for bloodborne pathogens (BBPs)?
* Eye Protection
* Safety Needles
* Dispose sharps immediately after use
91
What are examples of biological hazards in healthcare related to respiratory transmission?
* TB
* Measles
* Chickenpox
* Disseminated zoster/varicella
* Pertussis
* Influenza
* Adenovirus
* Rhinovirus
92
What are examples of bloodborne biological hazards in healthcare?
* HIV
* Hepatitis B
* Hepatitis C
* Hemorrhagic fever viruses
* Syphilis
* Malaria
* Zika
93
What are some examples of fecal-oral biological hazards in healthcare?
* **Norovirus**
* C. dif
* Salmonella
* Shigella
* Hepatitis A
