12 Staff health

Question 1

What is the role of the occupational health department?

Answer 1

◆ P rimary health screening of all staff by questionnaire and/or medical examination.
◆ Keeping accurate and up-to-date records of all members of staff.
◆ Immunization of all existing staff at the required time interval.
◆ Training of all grades of staff in personal hygiene and prevention and management
of sharps injuries.
◆ E xamination of staff returning to work after absence due to diarrhoea or other
infectious conditions to ensure that the infection has cleared and to give advice to
the chronic carrier.
◆ Determining staff contacts of the infectious disease (e.g. tuberculosis, blood-borne
viruses) and checking immunity and follow-up if necessary. Arranging tests and
possibly treatment for staff with infectious diseases.
◆ Keeping records of all inoculation injuries, arranging post-exposure prophylaxis
following inoculation injuries, and counselling of staff if necessary.
◆ Survey potential infective and toxic hazards (e.g. chemical disinfectant) to staff in
health care facilities.

Question 2

Which vaccines should be offered to staff?

Viruses only

Answer 2

VZV - check personal history of chickenpox. If clear history, then no need for immunisation. If unclear, check VZV IgG and immunise

HBV - vaccinate and check levels 1 month after completing course

Polio booster after 10 years - if handling lab samples

Question 3

Staff member with chickenpox

How long to exclude from work?

Answer 3

Until lesions are all dry and crusted

Question 4

Staff member exposed to chickenpox

Do they need excluded from work?

Answer 4

If immune, then continue as normal

If non-immune
◆ Exclude from duty from 8–10 days after first exposure (as chickenpox is infectious 2 days prior to onset of rash) through to
21 st day; 28 th day if VZIG given after last exposure. They should be instructed to take twice daily temperatures and to remain at home if they are febrile, as this could be the first sign of a prodromal varicella illness

Question 5

Baby on neonatal unit with CMV

Staff members anxious about acquiring infection.

What infection control procedures are required?

Answer 5

No restriction - standard infection control procedures e.g hand hygiene

Question 6

Staff member has enteroviral infection

does staff member need to stay off work?

Answer 6

Not necessarily

Advise avoid caring for neonates/ immunocompromised until symptoms resolve

Question 7

Staff member with Hepatitis A

How long should they be off work?

Answer 7

Until 7 days after onset of jaundice

Question 8

Staff member with Hepatitis E

How long should they be off work?

Answer 8

No clear evidence

Likely restrict from work for 7-14 days after onset of jaundice

Question 9

Staff member with herpetic whitlow

Do they need to be off work?

Answer 9

No restriction as long as follows standard precautions - including wearing gloves

However, if high risk e.g immunocompromised, or surgeon, likely restrict until lesion is dry and crusted over

Question 10

Staff member with Measles

How long should they be off work?

Answer 10

for 7 days from day of rash onset

Question 11

Staff member exposed to measles - they are non-immune

Should they be off work?

Answer 11

exclude from 5th day after exposure, through to 21st day after exposure

Question 12

Staff member with mumps

How long should they be off work?

Answer 12

exclude from day 1 to day 9 after onset of parotitis

Question 13

Staff member contact with mumps - known to be non-immune

How long should they be off work?

Answer 13

Exclude from duty 26 th day after last exposure or until 9 days after
onset of parotitis

Question 14

Staff member with norovirus

How long should they be off work?

Answer 14

72 hours after symptoms resolve

Question 15

Staff member with influenza/ parainfluenza

How long should they be off work?

Answer 15

Until symptoms have fully resolved

Question 16

Staff member with rubella

How long should they be off work?

Answer 16

until 5 days after rash appears

Question 17

Staff member exposed to rubella - known to be non-immune

How long should they be off work?

Answer 17

Exclude from duty from 7 th day after first exposure through 21 st day after last exposure

Question 18

Needlestick/ splash injury

What fluids are considered low risk?

Answer 18

urine, vomit, saliva (with the exception of dentistry) and faeces, unless they are visibly stained
with blood or originated from patients with suspected/confirmed infection.

Question 19

Needlestick/ splash injury

What fluids are considered high risk?

Answer 19

High-risk body fluids and tissues include blood and body fluids contaminated with
blood, amniotic fluid, vaginal secretions, semen, human breast milk, cerebrospinal
fluid, peritoneal fluid, pleural fluid, pericardial fluid, synovial fluid, saliva (in association
with dentistry) and unfixed tissues and organs

Question 20

NSI

How to evaluate total risk?

Answer 20

Determine risk of event - type of fluid, how deep the exposure, whether skin borken, what type of needle was used

Evaluate source- MSM/ IVDU or known BBV infection

Evaluate expsoed HCW - do they need HBV booster

Question 21

What are exposure prone procedures?

Answer 21

When there is a risk a patient being exposed to blood of the doctor

e.g dentistry, or open surgery where hands are not always visible

Procedures where the hands and fingertips of the worker are visible and outside the patient’s body at all times,
and internal examinations or procedures that do not involve possible injury to the worker’s gloved hands from sharp instruments and/or tissues, are not considered to be exposure-prone, provided routine infection control procedures are adhered to at all times.

Question 22

You are trying to decide if a patient has had contact with an infected staff member

What criteria would you use

Answer 22

Face-face contact

in same room for 15mins