International Travel Health And Safety Programs- Done Flashcards
Expatriates, their families and business travelers are at risk for…
- Infectious disease
- Food borne illness
- Injuries
- Threats to personal safety and security
American companies operating globally generated —- of revenues outside of the US
31%
Potential problems for long-term assignees
- Emotional and mental health conditions
- Isolation
- Culture shock
- Family conflict
International travel health and safety programs are designed to:
- Prepare workers for travel and international assignment
- Provide consultation and recommendations
- Prevent illness and injury
- Provide appropriate vaccinations
- Ensure, to the greatest extent possible, the personal safety of the traveler
Employers are primarily responsible for:
- Developing travel policies and procedures
- Allocating sufficient resources for the program
- Providing appropriate travel agency services and travelers assistance program vendors
- Provide destination appropriate health and safety information
- Requesting security information from destination hotels or other accommodations
- Providing medications, supplies, vaccinations, and counseling necessary for traveler’s health and safety
- Assessing and evaluating health care services in locations will be visiting/living and identifying resources for health and safety emergencies
- Educating workers of the international travel health program prior to implementation and regularly communicate changes or updates as travel health and safety issues develop
Security information that should e requested from destination hotels or other accommodations
- Deadbolts and viewholes on the doors
- Fire safety
- 24 hour security
- Safety deposit boxes
Occupational and environmental health nurses primary responsibilities include:
- Obtaining traveling workers health history
- Determine and provide appropriate immunizations
- Conduct a physical exam
- Perform laboratory or other diagnostic tests as appropriate
- Review special health and safety considerations for the traveler
- Providing counseling for occupational, environmental, and psychologic health and safety risks
- Refer the worker for treatment of travel related problems and follow-up on referral recommendations
Components of traveling workers health history
- Past or present significant physical or mental health conditions, injuries or surgeries
- Identify health conditions and risk factors that could compromise travel plans
- List any scars or permanent identifying markers on workers body in case identity needs to be confirmed
- Review any health problems encountered related to previous travel
- Medications
- Review current health, vision and dental status and provide appropriate interventions or referrals
- Allergies
5.
How do you determine and provide appropriate immunizations?
- Review immunization status
- Determine vaccines required and recommended for destination
- Administer or provide resources for appropriate vaccines
- Report adverse vaccine reactions
How do you determine how to conduct a physical exam?
Based on:
- Health and safety risk
- Duration of travel or assignment
- Destination
Laboratory and diagnostic tests may include:
- CBC
- Chemistry panel
- Urinalysis
- Blood type
- HIV testing
- TB testing
- Chest x-ray
- EKG
- Health surveillance screening appropriate for job assignment
Responsibilities of the traveling worker:
- Maintain a current passport and obtain visa and other necessary documents
- Ensure adequate time is available for vaccine administration, 4-6weeks
- Prepare a travel itinerary with contact info and give copy with family and office staff
- Confirm travel arrangements
- Review and follow all safety procedures
- Prepare emergency contact list
- Consider obtaining and carrying personal medical record
- Obtain sufficient amount of necessary prescriptions
- Obtain and wear emergency medical identification if needed
Safety issues should be addressed as follows:
- Since business travelers usually travel alone, avoid daring attention to oneself as business traveler
- Provide current information on political and social climate
- Encourage use of travelers check and bank cards instead of cash
- Discuss methods to reduce risk of theft
- Review travelers itinerary
Examples of information on political and social climate that should be given to traveler
- Risk of terrorism
- Risk of kidnapping
- Risk of theft
- Risk of crime
What items should be reviewed on travelers’ itinerary for health and safety education?
- Length of stay at each destination
- Type of work to be performed
- Specific hazards associated with the work to be done
- Type of accommodations
The following factors may add to the stress of business travelers:
- Sleep disturbances
- Isolation
- Cultural differences
- Job performance requirements
- Tight schedules
- Sudden departures
- Separation from family and home
- Fear of potential for kidnapping and terrorism
If a worker is traveling internationally for short term assignment it may be appropriate to:
- Discuss living accommodations and schedules
- Help traveler understand the culture of the destination country and advise on culturally appropriate dress and behaviors
- Provide traveler with resources for health care or emergency situations
- Provide information on safe driving in destination country
Workers who have long term international assignments may need assistance dealing with:
- Loneliness
- Job demands
- Living in hotels
- Traveling alone
In order to prepare the worker for a long term international assignment, it may be helpful to:
- Offer training and country specific cultural programs
- Provide a copy of appropriate evacuation procedure
- Identify resources for health or psychologic concerns
- Offer information for dependents if family will also be living abroad
Traveler’s diarrhea can be caused by…
Food or water contaminated with bacteria, viruses or parasites
The following high risk foods should be avoided in the international work environment
- Uncooked meat, poultry or seafood
- Raw fruits or vegetables
- Tap water, including ice made from tap water
- Unpasteurized dairy products
Prevention of food and water born illnesses may be further enhance by the following recommendations:
- Give hepatitis A vaccine for high endemic areas
- Drink bottled water
- Follow basic principles for safe handling of foods
- Follow basic principles of good hygienic practice
Management of traveler’s illnesses related to food and water born diseases
- Oral rehydrating fluids for diarrhea
- Prophylactic antibiotics to prevent certain bacteria caused illnesses
- Good hygienic practices to avoid reinfection
Essential traveler’s medical kit
- An adequate supply of medications for health conditions specific to the traveler
- Additional prescriptions (with the generic names) as determined by physician
- Copies of medical and eyeglass prescriptions
- Disposable thermometers
Nonprescription items for traveler’s medical kit
- Analgesic
- Antibiotic skin ointment
- Antiseptic
- Anticonstipation
- Antidiarrheal
- Anti-motion sickness
- Antihistamines
- Adhesive bandages
- Antacids
- Oral rehydrating salts
- Water purification tablets
Prescription items for traveler’s medical kit
- Altitude sickness prophylactics
- Antibiotics
- Antimalarials
- Sleeping medications
Additional medical supplies for traveler’s medical kit
- Disposable syringes and needles
- Latex gloves
- Skin closures (steri-strips)
- Suture removal kit
To control communicable disease, it is imperative that the occupational and environmental health nurse assess ————
Immunization status
Health maintenance recommended immunization information and schedules can be found at….
Center’s for Disease Control and Prevention’s National Immunization Program Website
Recommendations based on age and risk factors include immunizations for:
- Tetanus and diphtheria
- Hepatitis A and B
- Influenza
- Pneumonia
- Measles, mumps and rubella
- Polio
Other country-specific recommended or required vaccinations for travel may include:
- Yellow fever
- Typhoid
- Cholera
- Rabies
- Meningitis
- Japanese encephalitis
Malaria
Febrile illness caused by four different species of the protozoan parasite Plasmodium
Four species of protozoan parasite that can cause malaria
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium ovale
- Plasmodium malariae
Malaria cause by ——- results in severe disease and increased mortality risks
Plasmodium falciparum
Plasmodium is transmitted via….
Infected saliva following the bite of the female Anopheles mosquito
Signs and symptoms of malaria include:
- Fever
- Chills
- Headache
- Nausea
- Vomiting
- Myalgia
- Diarrhea
Most indicative sign of malaria infection
Fever
Risk of malaria indirectly related to….
Mosquito exposure
The highest rate of mosquito activity occurs in…
Africa
Risk of exposure is highest between —— and —— when mosquito activity is the highest
Dusk and dawn
The risk of mosquito exposure increase during….
Rainy and hot seasons
Prevention of malaria involves avoiding mosquito exposure by the following methods:
- Stay indoors during increased mosquito activity
- If outdoors, wear long sleeved clothing, long pants and hat
- Use repellents contains DEET
- Sleep under mosquito bed netting treated with a permethrin insecticide
- Sleep in screened or air conditioned rooms if possible.
DEET
N, N-diethyl-3-methylbenzamide
Antimalarial medications (chemoprophylaxis) include:
- Mefloquine
- Doxycycline
- Chloroquine
- Atorvaquone/ proguanil
True or false
There is a malaria vaccine
False
Travelers who have not taken malaria prophylaxis, are in an area resistant to the medications they were treated with or can not access urgent medical care can be give a self treatment course of:
Atovaquone/ proguanil
When should traveler initiate self treatment course of atovaquone/ proguanil?
At the onset of flu like symptoms and/or fever
Other country-specific diseases that may be of concern to travelers
- Dengue fever
- Monkey pox
- Lassa fever
- Plague
- Tuberculosis
Education specific to STDs for individuals traveling abroad
- Individuals assigned to long term assignments are more likely to engage in casual sex than are short term travelers
- Discuss risk of engaging in casual sex abroad
- Encourage the use of condoms and other safe sex practices
- Warn about the effects of alcohol and drugs, which may contribute to careless sexual behaviors
- Discuss cultural attitudes concerning prostitution in the traveler’s destination country
Jet lag
The disruption of the traveler’s sleep wake cycle. It usually occurs when traveling over two or more time zones
Risk factors for jet lag
- Insomnia
- Fatigue
- Poor concentration
- Irritability
- Headache
- Myalgia
Prevention of jet lag
- Adjust sleep schedule
- Drink extra fluids
- Reduce coffee and alcohol consumption
- Exposure to light may help in resetting circadian rhythm
Altitude sickness
A cluster of symptoms cussed by lack of oxygen. It can be life threatening.
Symptoms of altitude sickness
- Headache
- Shortness of breath
- Lightheadedness
- Fatigue
- Insomnia
- Loss of appetite
- Nausea
Risk factors for altitude sickness
- Ascent over 6000 feet
- Rapid ascent without acclimation
- Obesity
- Strenuous activity in high altitudes
- Use of sleeping pills or sedatives
- Previous history of altitude sickness
Prevention of altitude sickness
- High carbohydrate diet
- Extra fluid intake
- Reduce strenuous activity
- Slow, gradual descent
- Acetazolamide (250mg every 8 hours for 3-5 days before ascent)
Treatment of altitude sickness
- Descent and rest
- Aspirin or acetaminophen
- Diamox
Post traveler evaluation for long term travelers
- Provide immediate evaluation for signs and symptoms of illness
- Post travel-assessment that is traveler specific, like history and physical including labs, post travel debriefing
- Obtain worker’s feedback to assist in the evaluation of the international health and safety program
History and physical exam, including laboratory and other diagnostic tests that may be done as part of a post long term travel evaluation:
- CBC, chemistry panel and urinalysis
- Stool for ova and parasite if coming from hi risk area
- TB testing
- Chest x-ray (as required by country)
- Health surveillance as appropriate for job exposures (eg PFTs, audiogram)
Post-travel debriefing following long term travel includes:
- A discussion of problems encountered during travel/stay
- Recommendations for future travelers
- Referral to a primary health care provider for routine health maintenance screening as appropriate
- Referral for routine vision and dental screening as appropriate
Ways to use feedback obtained from workers about the international health and safety program
- Use this information to analyze the program’s effectiveness and efficacy
- Analyze the cost/benefit ratio of the program’s elements
- Evaluate the overall effectiveness and cost of the program
- Make revisions as appropriate based on this information
