Standards And Guidelines In Relation To Occupational Exposure To Infectiius Agents Flashcards
What do the WHO international health regulations 2005 do?
Define Public Health Emergencies of International concern (PHEIC)
Holds a list of diseases whose occurrence must always be notified to WHO (small pox, wild type polio, new subtypes of human influenza and SARS)
Holds algorithm for countries to decide whether other incidents might constitute a PHEIC.
What might constitute a PHEIC?
A case of VHF in a country
Who should a PHEIC be reported to?
The agency designated as the National Focus.
They are responsibly for notifying the WHO.
Who is the National Focus in England?
Public Health England
What are the three pieces of UK health and safety legislation covering occupational exposure to infectious agents?
Health and Safety at work Act 1974
Control of Substances Hazardous to Health Regulations 2002 (COSHH)
Reporting of Injuries, Disease and Dangerous Occurrences Regulations 2013 (RIDDOR)
What are the key outlines of the Health and Safety at work Act 1974?
Duty on EMPLOYERS to ensure as far as is reasonable practicable, the health, safety and welfare of workers.
Including provision of: PPE, Occupational health services, Vaccines and other protective measures to reduce the risk of exposure to infectious agents.
Duty on EMPLOYEES to cooperate with employers to comply with health and safety legislation.
What is the key summary/intentions of COSHH 2002?
protect workers from the risks of exposure to substances with the potential to cause harm if they are inhaled, ingested or come into contact with or are absorbed through the skin.
Substances = chemical or biological agents.
What does the definition of biological agent include, as set out by COSHH?
Micro-organisms inc bacteria, viruses, fungi and prions (TSEs)
Parasites e.g malarial parasites, amoebas and trypanosomes
Larger parasites e.g. microscopic ova and larval forms of helminths.
Define category ‘a’ of exposure to biological agents as set out by COSHH
Deliberate intention to work with a biological agent i.e. research, teaching or diagnosis.
Define category ‘b’ of exposure to biological agents as set out by COSHH
Exposure arises out of the work activity but is incidental to it i.e. not direct work with agent itself e.g. health care, food production, refuse disposal
Define category ‘c’ of exposure to biological agents as set out by COSHH
Exposure which does not arise out of the work activity itself e.g. respiratory infection from one worker to another
Which categories of exposure does COSHH apply to?
A and B
Which characteristics are used to classify biological agents into their hazard groups?
Ability to cause infection
Severity of disease that may result
Risk that the infection will spread to the community
Availability of vaccines and effective treatment.
Define Group 1 categorisation of biological agents under COSHH
Unlikely to cause human illness
Define Group 2 categorisation of biological agents under COSHH
Can cause human disease and may be a hazard to employees.
Unlikely to spread to the community
Effective prophylaxis or treatment available
Define Group 3 categorisation of biological agents under COSHH
Cause severe human disease and may be serious hazard to employees
may spread to the community
usually effective prophylaxis or treatment
Define Group 4 categorisation of biological agents under COSHH
Causes severe human disease and is a serious hazard to employees
likely to spread to the community
usually no effect prophylaxis or treatment available.
Examples of Hazard group 3 organisms
B. anthracis Burkholderia pseudomallei C. burnetti E. coli 0157 Salmonella typhimurium Echinococcus granulosus Penicillium marneffei Rabies HIV SARS virus Flaviviruses inclduing: Dengue, west nile and yellow fever
Examples of Hazard Group 4 organisms
Ebola virus
Marburg
Lassa fever
What does ACDP stand for and what does it do?
Advisory committee on Dangerous Pathogens
Categorises infectious agents into groups 2-4 as described in COSHH
What are the key aims/intentions of RIDDOR?
Ensure that injuries, accidents and dangerous incidents arising from work are reported to the relearnt enforcing authority.
Includes reporting of acute illness requiring medical treatment due to exposure of infectious agent, its toxin or infected material. e.g. needlesticks
Includes reporting of notifiable occupational disease
Statutory - reportable by law.
Name some examples of guidelines available at national level to reduce the risk of exposure to infectious agents
The Health and Safety Executive
The Department of Health
The Health Protection Agency
Examples of guidelines set out by local NHS organisations to reduce the risk of exposure to infectious agents
Organisation or departmental policies
Occupational health policies
infection prevention and control policies.
Name three other UK surveillance mechanisms for exposure to infectious agents at work
SIDAW - surveillance of infectious disease at work
UK surveillance of significant occupational exposures to blood borne viruses in healthcare workers by the HPA
Local surveillance schemes i.e. they eye of the needle.
List common occupational infections
Hepatitis B, Hepatitis C and HIV
Measures put in place to reduce risk of occupational infections
PPE,
Safe management of sharps.
Immunisation
Prompt management of sharps and contamination incidents in the work place.
How is contracting Hep B prevented?
Vaccination of workers at high risk
Risk reduction in work place
What is the post exposure management for Hep B
Vaccination or booster for already vaccinated
Immunoglobulin (HBIG) in non-responders to vaccine or if exposure is from HR source.
Serological follow up - baseline, 6 months post-exposure
How is Hep B treated?
IFN/Peg-IFN aplha 2a
Antivirals - adefovir, telbivudine, entecavir
What guidelines are available surrounding occupational Hep B?
Immunisation against infectious disease - The Green Book
Exposure to Hep B virus: guidance on PEP
How is contracting Hep C prevented?
Risk reduction in the workplace
NO VACCINE
What is the post exposure management for Hep C?
Serological follow up - baseline, 6, 12, 24 weeks post exposure
How is Hep C treated?
Peg-IFN alpha + Ribavirin
What guidelines are available surrounding occupation Hep C?
Guidance on the investigation and management of occupation exposure to Hep C - PHE
How is contracting HIV via occupation prevented?
Risk reduction in the work place
What is the post exposure management for HIV?
Serological follow up (Baseline, 12 weeks post incident or 12 weeks post cessation of PEP)
PEP with anti-retroviral therapy within 24-72 hours of exposure
How is HIV treated?
Highly active anti-retroviral therapy (HAART)
2 NRTIs + PI/NNRTI/INSTI
What guidelines are available surrounding occupational HIV?
HIV PEP: guidance from UK Chief Medical Officers Expert Advisory group on AIDS.
How is contracting meningococcal infection via occupation prevented?
Vaccination - conjugate MenC, conjugate ACWY, Men B vaccine
Risk reduction in the workplace
What is the post-exposure management for meningococcal infection?
PEP - ciproflocacin, rifampicin within 24 hours - 28 days
Vaccination
What guidelines are available surrounding occupational meningococcal disease?
Immunisation against infectious diseases
Guidelines for public health management of meningococcal disease in the UK.
How is contracting TB occupationally prevented?
Vaccination - BCG to HR grouos
Risk reduction in work place
What is the post-exposure management for TB?
Screening - mantoux, IGRA, Chest Xray
Vaccination - if neg tests/no previous BCG
Chemoprophylaxis - Isoniazid and Rifampicin for 3 months if latent TB diagnosed
How is TB treated?
Rifampicin, Isoniazid, Ethambutol, Pyrazinamide
How is occupation Legionnaires disease prevented?
Risk assessment and management of water systems
How is Legionella treated?
Antibiotics - Ciprofloxacin IV ADD Clarithromycin IV in severe disease
How are occupational gastrointestinal and zoonotic infections prevented?
Good personal hygiene Good occupational hygiene practices Education and awareness Limiting exposure especially where vulnerable/high risk groups are concerned Good husbandry practices
How are GI/zoonotici infections treated?
Supportative.
Abx not usually required
HUS may require dialysis
How is contracting Hepatitis A occupationally prevented?
Immunisation
Hand hygiene, safe handling of specimens
What is the post-exposure management for Hep A occupationally?
immunisation - 2 weeks after exposure
Human normal Immunoglobulin (HNIG) - in HR cases
What is the treatment for Hep A
None, self limiting
How is contracting Influenza occupationally prevented?
Annual immunisation
Good occupational hygiene practices (Good ICN, PPE, hand washing, safe handling of specimens)
How is Influenza treated?
Supportive
Antivirals - oseltamivir, zanamavir, amantadine for HR patients
What exposure is Leptospirosis associated with?
Rat urine or exposure to water
How is contracting Leptospirosis occupationally prevented?
PPE,
Control of rodents,
Cover cuts and abrasions with waterproof dressings if coming into contact with potentially infected water
Prophylactic doxycycline short course for HR occupations
How is leptospirosis treated?
Oral peniciillin or doxycycline
IV abx and intensive support for severe cases.
How is Anthrax prevented occupationally?
Immunisation
What is the post-exposure management for Anthrax?
PEP - Ciprofloxacin or doxycycline
Immunisation
What is the treatment for Anthrax?
Ciprofloxacin
How is lyme disease prevented?
Tick avoidance,
Education and awareness
How is lyme disease treated?
Doxycycline or amoxicillin
How is occupational Rabies prevented?
Immunisation - lab and bat workers
Education and awareness
What is the post-exposure management for Rabies?
Immunisation and Rabies immunoglobulin (HRIG) - requires risk assessment, both very effective.
What is the treatment for rabies?
Supportive - often fatal. No cure
How is tetanus prevented ?
Immunisation - everybody
Cover cuts and abrasions if working with soil or outdoors
What is the post-exposure management for Tetanus?
Immunisation Tetanus Immunoglobulin (TIG) for HR exposures
What is the treatment for Tetanus?
Supportive,
TIG
Metronidazole
How is Brucellosis prevented occupationally?
PPE, Hand hygiene
What is the post-exposure management for Brucellosis?
Serological follow up
What is the treatment for Brucellosis?
Doxycycline and Rifampicin
How is Q- fever prevented occupationally?
PPE, Hand hygiene
Good animal husbandry
How is q-fever/coxiella burnetti treated?
Doxycycline or Tetracycline
How is VHF prevented?
PPE
What is the post-exposure management for VHF?
Clinical surveillance - monitor for signs and symptoms
How is VHF treated?
Supportive,
Ribavirin for Lassa fever if given early may be beneficial
