Occupational Health �Employee Health�for the IP ��
Key Concepts
Key Concepts
Key Concepts
Background
Employee Health Plan and Risk Assessment
HCP
Health Care Personnel
HCP: A Definition
Design of an OH/EH Program
Design
Design
Design
Design
Immunization Programs
Recommended immunization practices are addressed by the US Public Health Service’s Advisory Committee on Immunization Practices (ACIP)
Resources
Immunization of Health-care Personnel
Hepatitis B
Hepatitis B | Give 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). Give IM. Obtain anti-HBs serologic testing 1–2 months after dose #3.
New 2 dose vaccine (HEPLISAV-B) give 2 doses IM, 1 month apart. Obtain anti-HBs serologic testing 1–2 months after dose #2. |
| Hepatitis B recombinant vaccine |
| For HCWs at risk of exposure to blood and body fluids |
| Test for immunity 1-2 months following 3rd dose |
| If declines must sign declination statement. |
Influenza (reportable to NHSN)
INFLUENZA | Give 1 dose of influenza vaccine annually. Give inactivated injectable influenza vaccine intramuscularly or live attenuated influenza vaccine (LAIV) intranasal. |
| All HCPs with direct patient care, however emphasis should be on ALL HCP. |
| Contraindicated if SEVERE egg allergy only. Egg –free vaccine now available. |
| Declination if not taking flu vaccine (CMS) |
| Begin staff education stressing the importance of immunization annually |
Mumps, Measles, Rubella�
MMR | For healthcare personnel (HCP) born in 1957 or later without serologic evidence of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. Give SC. |
| HCP born in 1957 or later can be considered immune to measles, mumps, or rubella ONLY if they have documentation of (a) laboratory confirmation of disease or immunity, or (b) appropriate vaccination against measles, mumps, and rubella (i.e., 2 doses of live measles and mumps vaccines given on or after the first birthday, separated by 28 days or more, and at least 1 dose of live rubella vaccine). |
| Consider recommending 2 doses of MMR vaccine routinely to unvaccinated HCP born before 1957 who do not have laboratory evidence of disease or immunity to measles and/or mumps, and should consider one dose of MMR for HCP with no laboratory evidence of disease or immunity to rubella. |
Varicella
Varicella | For HCP who have no serologic proof of immunity, prior vaccination, give 2 doses of varicella vaccine, 4 weeks apart. Give SC. |
| Evidence of immunity in HCP includes documentation of 2 doses of varicella vaccine given at least 28 days apart, laboratory evidence of immunity, or physician confirmation of disease. |
Tetanus diphtheria acellular pertussis Tdap
Tetanus, Diphtheria and Pertussis | Give a one-time dose of Tdap as soon as feasible to all HCP who have not received Tdap previously. Give Td boosters every 10 years thereafter. |
| Start with high risk areas such as Pediatrics, Nursery, NICU, and ER. Respiratory personnel. |
Meningococcal
Meningococcal | Vaccination is recommended for microbiologists who are routinely exposed to isolates of N. meningitidis. |
| Preferred vaccine is MCV4 for HCP Meningococcal conjugated vaccine – 4 types of meningitis |
| Use MPSV4 (polysaccharide) only if there is a permanent contraindication or precaution to MCV4. |
| Use of MPSV4 (not MCV4) is recommended for HCP older than age 55. |
References
1. CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 2011; 60(RR-7).
Post Exposure Management
Post Exposure Management
Index case- verify the diagnosis
Is the patient infectious?
Yes
No
Was barrier protection absent or breached?
No action
Yes
No
No action
Identify exposed individuals
Is individual susceptible?
No
Yes
No action
Does disease have potential for further spread?
No
Yes
Do therapeutic measures for treatment exist?
No
Yes
Monitor employee for symptoms/work restrictions
Implement intervention measures
Tuberculosis
TB evaluation of NEW employees
Annual TB evaluation
Annual TB evaluation
Employee fit testing for N-95 respirator
OSHA requires fit testing
Fit testing Procedures
Quantitative Fit Test (QNFT) Protocols
Technique Matters !
Technique
Measure induration only not the redness.
Protocol for Occupational Exposure to Pertussis Supplement A
Documented occupational exposure
to confirmed Pertussis case
Azithromycin 600 mg/day
orally
for five (5) days
If macrolide tolerant
If macrolide intolerant
TMP-SMX 320/1600 mg
/day
in two divided doses orally
for fourteen (14) days
VARICELLA EVALUATION
Consider immune
Consider non-immune
All new hires
Positive history of chicken pox
OR
Positive history of vaccination
Unknown history of chicken pox
OR
Negative or unknown history of
vaccination
Draw VZIG
If positive,
consider immune
If negative,
offer vaccine
Staff Exposed to Varicella
Report to Staff Health & Safety
(Occupational or Community Exposure)
History of Varicella
Vaccinated or
unknown history
Negative VZIG
Consider immune
Offer vaccine if
within 72 hrs or
VZIG within 96 hrs
Consider non-immune
appear
Draw VZIG
Positive
Staff Health to verify as
Varicella (IgM, IgG and
vesicle culture for VZV)
Defining Exposure
|
MENINGOCOCCAL MENINGITIS EXPOSURE Definition of Exposure: Contact with or face to face (mouth to mouth resuscitation, intubation, suctioning to infectious person’s respiratory secretions Timeframe for Prophylaxis: Within two days of date of first exposure Incubation Period-2 to 10 days |
VARICELLA (CHICKENPOX) EXPOSURE Definition of Exposure: Direct contact with vesicles or airborne (shared air contact) with infectious person Timeframe for Prophylaxis: Within 96 hours of exposure for seronegative and unvaccinated, immunocompromised or pregnant staff Incubation Period-10-28 days The following employees have authority to initiate the above prescriptions as needed for occupational exposures: |
|
BBP Exposure�
BBP exposure Follow-Up
Post Exposure Interventions
Work Restrictions
Workman’s Compensation
Workman’s Compensation
Workman’s Compensation
Measuring Improvement in Occupational Exposure Prevention
Rates measuring performance
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