MICRO 5 – Introduction to Infection Control Aspects of Occupational Health

Question 1

What is Occupational Health?

Answer 1

Traditionally defined as the specialty concerned with the:
effects of work on health &
how health affects an individual’s capacity to work

Question 2

What is the Complex web encompassing of Occupational Health?

Answer 2

work and work environment
life and lifestyle
health and ill health

Question 3

What is healthy worker effect?

Answer 3

HWE refers to the consistent tendency for actively employed people to have a more favorable mortality experience than the population at large.

Question 4

Name the positive effects of work on health health

Answer 4

Creates a sense of wellbeing through:
>Achievement of job satisfaction
>Provision of means of income
>Social interaction
>Potential to interact with worksite health promotion activities

Question 5

What are the negative effects of work on health?

Answer 5

Specific physical job hazards
Accidents at work
Long working hours
Job insecurity
Excessive demands

Question 6

Name the work place hazards

Answer 6

Physical +ergonomic
Biological
Chemical
Physical /human

Question 7

Give the example of physical +ergonomic work hazards

Answer 7

Noise
Radiation
Trip hazards
Manual handling
Ergonomic

Question 8

What are the possible chemical work place hazards?

Answer 8

Solvents
Irritants
Carcinogens

Question 9

Name the biological work place hazards

Answer 9

Bacteria
Fungus
Other micro-organism

Question 10

What does an occupational healthcare service provide?

Answer 10

Risk assessment and risk control
Pre-employment + periodic assessments
Management of occupational illness and injury
Post-illness / absence reviews
Vaccination + post-exposure prophylaxis
Management of staff (infections, dermatitis etc)
Health education
Counselling
Advice

Question 11

Who may be at risk at a health facility?

Answer 11

Nurses
Doctors
Laboratory staff
Dentists/hygienists
HSCP
Morticians
Staff of residential institutions
Students
Porters
Contract cleaners

Question 12

What are the examples of work related ill health in the health service?

Answer 12

Musculoskeletal disorders
Psychological illness / stress
Dermatitis
Accidents (including NSI)
Infectious disease
Asthma

Question 13

How can occupational health affect infection control?

Answer 13

Knowledge of legislative backdrop and sometimes competing needs and demands
Understanding of management structure and responsibilities / limitations
Competent at risk assessment and risk communication
Awareness of health / medical issues as well as human factors
Can provide impartial advice without compromising confidentiality

Question 14

State Infection Control Objectives of an Occupational Health Programme

Answer 14

1. Education
2. Risk Assessment
3. Risk Control
4. Evaluation

Question 15

What topics are healthcare staff educated on?

Answer 15

Standard and transmission-based precautions
Consequences of non-compliance
Exposures to potentially infectious hazard
*Prevention
*Action to take and management if exposed

Question 16

Explain legislation in relation to occupational hazards

Answer 16

> Employees are protected by law from exposure to occupational hazards
The Biological Agents Regulations (2013) require the prevention of exposure of employees to a biological agent in a place of work. Schedule 4 specifies:
-Offer vaccine (FOC)based on risk assessment
-Inform re benefits and drawbacks
-Vaccination certificate may be drawn up
The Health & Safety Act (2005) includes microorganisms in its definition of substances. Therefore, protection against microorganisms is given the same legal standing as protection against other hazards in the workplace
EU Sharps Directive 2013

Question 17

What are the employee responsibilities (HSA)?

Answer 17

Co-operate with your employer and others.
Do not take chances with your life or your colleagues.
Tell your employer if you think something is dangerous.
Do not interfere with or misuse safety equipment.
Use equipment correctly.
Attend training.
Use protective equipment and clothing provided.

Question 18

Write down risk assessment procedure

Answer 18

> Identify the potentially infectious hazard
in the workplace
(something that can cause harm)
Determine level of occupational risk for each hazard (ie the risk of exposure to the particular hazard)
Risk = hazard X frequency
Identify what controls are necessary using the hierarchy of risk controls = Risk Control

Question 19

What knowledge is required in the risk assessment?

Answer 19

• The workplace, its hazards, consequences
• Likelihood of exposure
• Individual vulnerability
• Epidemiology
• Clinical manifestations
• Routes of transmission
• Respiratory: droplets, aerosols
• Contact: Patient handling /contaminated equipment Percutaneous / mucocutaneous: contact with blood or body fluids

Question 20

Biological Agents are classified into 4 groups. State this groups

Answer 20

Group 1 agents are the least hazardous
Group 4 are the most hazardous
Group 2&3:…include most of the vaccine preventable pathogens encountered in healthcare.

Question 21

State the basis of the classification of the 4 groups of biological agents

Answer 21

Whether;
>The agent is pathogenic to humans
>The agent is a hazard to employees
>The agent is transmissible to the community
>There is effective treatment or prophylaxis available

Question 22

Explain risk control

Answer 22

Eradication or minimisation of the risk of exposure to the potentially infectious hazard
Prevention of staff exposure to the risk
Management of staff exposure to the risk
Policies, procedures and programmes to prevent / manage exposures including outbreak management

Question 23

Explain healthcare worker vaccination

Answer 23

Healthcare workers, usually healthy adults, are likely to have excellent response to vaccination unlike some patients
Hospitalised patients can acquire influenza from infected healthcare workers, visitors or other patients
About 30% of people infected with influenza are asymptomatic but can still be infectious
Influenza can kill a vulnerable patient

Question 24

How do we protect ourselves from influenza?

Answer 24

Inactivated virus should be given each year in advance of the influenza season (Sept/Oct)

Question 25

Why is influenza vaccine administered every year?

Answer 25

Antigenic Drift” Minor antigenic change
Transcription errors by the viral DNA polymerase result in amino acid substitutions in surface glycoproteins of the influenza virus
Partial immunity in population (Little in infants, some cross-reacting immunity in adults) = YEARLY EPIDEMICS

Question 26

What are the determinants of influenza vaccination uptake amongst Hospital staff?

Answer 26

Age
Belief in vaccine efficacy
Belief in prior prevention of illness by vaccine
Knowledge of illness not a predictor
No gender difference

Question 27

What have other countries used?

Answer 27

Visible evidence of compliance:
Coloured lanyard
Wearing surgical mask during season
Declination tool
Mandatory vaccination

Question 28

How are staff exposed to biological risk managed?

Answer 28

Assess what happened (the incident)
Type of exposure + method of transmission
Compliance with infection control precautions (including PPE)
Assess the source of exposure (usually a patient)
Diagnosis of infection and how infectious they are
Assess the staff member
Determine immune status
Management of the staff member
>Diagnose infection
>Post-exposure prophylaxis or treatment if infected
>Counselling
>Work restriction/return to work
>Contact tracing

Question 29

What is a blood borne virus?

Answer 29

One that is transmitted parenterally;
Sharing equipment used by injecting drug users,
Haemodialysis, non-sterile glucometer equipment,
Sharing personal care items (toothbrushes, razors)
Needle stick injuries,Ear-piercing, tattooing, acupuncture
(hepatitis Bhepatitis CHIV*)

Question 30

What is the Risk of Blood borne Viral Transmission to Healthcare staff?

Answer 30

The risk of developing infection after blood exposure depends on:
Exposure type (sharps injury versus splash)
Exposure severity (depth of injury, amount of blood involved etc.)
((Rule of 3’s:
Hepatitis B + source = 1:3
Hepatitis C + source = 1:30
HIV+ source (percutaneous) = 1: 300
HIV+ source (mucocutaneous) = 1:9000
))

Question 31

What is a significant exposure?

Answer 31

It’s one from which transmission of A BLOOD BORNE VIRUS may result)
Percutaneous injury (cuts, abrasions or puncture wounds) with needles or other sharp instruments contaminated with blood or body fluids
or
Mucous membrane or non-intact skin contact with blood or body fluids (e.g., Splashes of blood etc into the eyes, nose or mouth)
or
Human bites where contact occurs between non-intact mucous membrane and broken skin.

Question 32

Explain how one deals with needle stick injuries

Answer 32

First AID ASAP
Decide if a significant exposure has happened
Assess the risk of transmissionTake bloods from both source and recipient
Treat the recipient
Follow up of recipient

Question 33

What are the precautions to ensuring it’s prevented

Answer 33

Safe systems of work
HEPATITIS B VACCINATION AND KNOW YOUR STATUS
Standard precautions
Gloves + wash hands
Cover any wounds or skin lesions
Clean any spillages immediately
Sharp safety
*NEVER RESHEATH NEEDLES
*DISPOSE YOUR OWN SHARPS IN THE SHARPS BOX – DON’T LEAVE THEM AROUND FOR SOMEBODY ELSE
Protective eyewear

Question 34

What are some reasons for breach in good Infection control practice?

Answer 34

Lack of information
Information available but ignored
Information available but not practised as routine
Good practice forgotten / overlooked in particular situation…distracted, in a hurry etc.
Good practice slips over time because of poor supervision, monitoring etc.

Question 35

Explain the 3P’s used in prevention

Answer 35

1.Prepare: Adequate training for procedure? Anticipate problems. Use correct equipment. Get assistance if needed-uncooperative pt.
2.Protect: Must remember basics of good infection control: cover cuts, protect myself and others, vaccines up to date,
Personal protective equipment.
3.Proceed: Ignore distractions. Do not resheath. Immediate disposal of sharp in CIN bin

Question 36

What is the progress rate of Hepatitis B over a decade?

Answer 36

Risk of hepatitis B down by >90%;
-Standard precautions
- Vaccine
<100% vulnerable staff immunised
Research: no significant change in the epidemiology of sharps injuries between 1998–2000 and 2008–2010 in an Irish teaching hospital.
Hepatitis B immunity in sharps injury recipients was relatively low (87%)
Resheathing had reduced significantly (p= <0.05)