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Infectious Disease In The Community And Hospital Setting > Standards And Guidelines In Relation To Occupational Exposure To Infectiius Agents > Flashcards

Standards And Guidelines In Relation To Occupational Exposure To Infectiius Agents Flashcards

1
Q

What do the WHO international health regulations 2005 do?

A

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.

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2
Q

What might constitute a PHEIC?

A

A case of VHF in a country

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3
Q

Who should a PHEIC be reported to?

A

The agency designated as the National Focus.

They are responsibly for notifying the WHO.

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4
Q

Who is the National Focus in England?

A

Public Health England

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5
Q

What are the three pieces of UK health and safety legislation covering occupational exposure to infectious agents?

A

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)

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6
Q

What are the key outlines of the Health and Safety at work Act 1974?

A

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.

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7
Q

What is the key summary/intentions of COSHH 2002?

A

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.

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8
Q

What does the definition of biological agent include, as set out by COSHH?

A

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.

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9
Q

Define category ‘a’ of exposure to biological agents as set out by COSHH

A

Deliberate intention to work with a biological agent i.e. research, teaching or diagnosis.

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10
Q

Define category ‘b’ of exposure to biological agents as set out by COSHH

A

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

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11
Q

Define category ‘c’ of exposure to biological agents as set out by COSHH

A

Exposure which does not arise out of the work activity itself e.g. respiratory infection from one worker to another

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12
Q

Which categories of exposure does COSHH apply to?

A

A and B

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13
Q

Which characteristics are used to classify biological agents into their hazard groups?

A

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.

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14
Q

Define Group 1 categorisation of biological agents under COSHH

A

Unlikely to cause human illness

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15
Q

Define Group 2 categorisation of biological agents under COSHH

A

Can cause human disease and may be a hazard to employees.
Unlikely to spread to the community
Effective prophylaxis or treatment available

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16
Q

Define Group 3 categorisation of biological agents under COSHH

A

Cause severe human disease and may be serious hazard to employees
may spread to the community
usually effective prophylaxis or treatment

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17
Q

Define Group 4 categorisation of biological agents under COSHH

A

Causes severe human disease and is a serious hazard to employees
likely to spread to the community
usually no effect prophylaxis or treatment available.

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18
Q

Examples of Hazard group 3 organisms

A 
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
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19
Q

Examples of Hazard Group 4 organisms

A

Ebola virus
Marburg
Lassa fever

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20
Q

What does ACDP stand for and what does it do?

A

Advisory committee on Dangerous Pathogens

Categorises infectious agents into groups 2-4 as described in COSHH

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21
Q

What are the key aims/intentions of RIDDOR?

A

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.

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22
Q

Name some examples of guidelines available at national level to reduce the risk of exposure to infectious agents

A

The Health and Safety Executive
The Department of Health
The Health Protection Agency

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23
Q

Examples of guidelines set out by local NHS organisations to reduce the risk of exposure to infectious agents

A

Organisation or departmental policies
Occupational health policies
infection prevention and control policies.

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24
Q

Name three other UK surveillance mechanisms for exposure to infectious agents at work

A

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.

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25
Q

List common occupational infections

A

Hepatitis B, Hepatitis C and HIV

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26
Q

Measures put in place to reduce risk of occupational infections

A

PPE,
Safe management of sharps.
Immunisation
Prompt management of sharps and contamination incidents in the work place.

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27
Q

How is contracting Hep B prevented?

A

Vaccination of workers at high risk

Risk reduction in work place

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28
Q

What is the post exposure management for Hep B

A

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

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29
Q

How is Hep B treated?

A

IFN/Peg-IFN aplha 2a

Antivirals - adefovir, telbivudine, entecavir

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30
Q

What guidelines are available surrounding occupational Hep B?

A

Immunisation against infectious disease - The Green Book

Exposure to Hep B virus: guidance on PEP

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31
Q

How is contracting Hep C prevented?

A

Risk reduction in the workplace

NO VACCINE

32
Q

What is the post exposure management for Hep C?

A

Serological follow up - baseline, 6, 12, 24 weeks post exposure

33
Q

How is Hep C treated?

A

Peg-IFN alpha + Ribavirin

34
Q

What guidelines are available surrounding occupation Hep C?

A

Guidance on the investigation and management of occupation exposure to Hep C - PHE

35
Q

How is contracting HIV via occupation prevented?

A

Risk reduction in the work place

36
Q

What is the post exposure management for HIV?

A

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

37
Q

How is HIV treated?

A

Highly active anti-retroviral therapy (HAART)

2 NRTIs + PI/NNRTI/INSTI

38
Q

What guidelines are available surrounding occupational HIV?

A

HIV PEP: guidance from UK Chief Medical Officers Expert Advisory group on AIDS.

39
Q

How is contracting meningococcal infection via occupation prevented?

A

Vaccination - conjugate MenC, conjugate ACWY, Men B vaccine

Risk reduction in the workplace

40
Q

What is the post-exposure management for meningococcal infection?

A

PEP - ciproflocacin, rifampicin within 24 hours - 28 days

Vaccination

41
Q

What guidelines are available surrounding occupational meningococcal disease?

A

Immunisation against infectious diseases

Guidelines for public health management of meningococcal disease in the UK.

42
Q

How is contracting TB occupationally prevented?

A

Vaccination - BCG to HR grouos

Risk reduction in work place

43
Q

What is the post-exposure management for TB?

A

Screening - mantoux, IGRA, Chest Xray
Vaccination - if neg tests/no previous BCG
Chemoprophylaxis - Isoniazid and Rifampicin for 3 months if latent TB diagnosed

44
Q

How is TB treated?

A

Rifampicin, Isoniazid, Ethambutol, Pyrazinamide

45
Q

How is occupation Legionnaires disease prevented?

A

Risk assessment and management of water systems

46
Q

How is Legionella treated?

A

Antibiotics - Ciprofloxacin IV ADD Clarithromycin IV in severe disease

47
Q

How are occupational gastrointestinal and zoonotic infections prevented?

A 
Good personal hygiene
Good occupational hygiene practices
Education and awareness
Limiting exposure especially where vulnerable/high risk groups are concerned
Good husbandry practices
48
Q

How are GI/zoonotici infections treated?

A

Supportative.
Abx not usually required
HUS may require dialysis

49
Q

How is contracting Hepatitis A occupationally prevented?

A

Immunisation

Hand hygiene, safe handling of specimens

50
Q

What is the post-exposure management for Hep A occupationally?

A

immunisation - 2 weeks after exposure

Human normal Immunoglobulin (HNIG) - in HR cases

51
Q

What is the treatment for Hep A

A

None, self limiting

52
Q

How is contracting Influenza occupationally prevented?

A

Annual immunisation

Good occupational hygiene practices (Good ICN, PPE, hand washing, safe handling of specimens)

53
Q

How is Influenza treated?

A

Supportive

Antivirals - oseltamivir, zanamavir, amantadine for HR patients

54
Q

What exposure is Leptospirosis associated with?

A

Rat urine or exposure to water

55
Q

How is contracting Leptospirosis occupationally prevented?

A

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

56
Q

How is leptospirosis treated?

A

Oral peniciillin or doxycycline

IV abx and intensive support for severe cases.

57
Q

How is Anthrax prevented occupationally?

A

Immunisation

58
Q

What is the post-exposure management for Anthrax?

A

PEP - Ciprofloxacin or doxycycline

Immunisation

59
Q

What is the treatment for Anthrax?

A

Ciprofloxacin

60
Q

How is lyme disease prevented?

A

Tick avoidance,

Education and awareness

61
Q

How is lyme disease treated?

A

Doxycycline or amoxicillin

62
Q

How is occupational Rabies prevented?

A

Immunisation - lab and bat workers

Education and awareness

63
Q

What is the post-exposure management for Rabies?

A

Immunisation and Rabies immunoglobulin (HRIG) - requires risk assessment, both very effective.

64
Q

What is the treatment for rabies?

A

Supportive - often fatal. No cure

65
Q

How is tetanus prevented ?

A

Immunisation - everybody

Cover cuts and abrasions if working with soil or outdoors

66
Q

What is the post-exposure management for Tetanus?

A 
Immunisation
Tetanus Immunoglobulin (TIG) for HR exposures
67
Q

What is the treatment for Tetanus?

A

Supportive,
TIG
Metronidazole

68
Q

How is Brucellosis prevented occupationally?

A

PPE, Hand hygiene

69
Q

What is the post-exposure management for Brucellosis?

A

Serological follow up

70
Q

What is the treatment for Brucellosis?

A

Doxycycline and Rifampicin

71
Q

How is Q- fever prevented occupationally?

A

PPE, Hand hygiene

Good animal husbandry

72
Q

How is q-fever/coxiella burnetti treated?

A

Doxycycline or Tetracycline

73
Q

How is VHF prevented?

A

PPE

74
Q

What is the post-exposure management for VHF?

A

Clinical surveillance - monitor for signs and symptoms

75
Q

How is VHF treated?

A

Supportive,

Ribavirin for Lassa fever if given early may be beneficial

Infectious Disease In The Community And Hospital Setting (5 decks)

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